Surgical tactics in the treatment of patients with hiatal hernias

Abstract

Background. The purpose was to develop indications for surgical treatment of patients with hiatal hernias and evaluate its results. Materials and methods. At the Department of Surgery of Digestive Organs of SI “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”, 45 patients with hiatal hernias were examined in 2017–2019. Long-term treatment results were studied within 6 months to 2 years in 19 (42.2 %) individuals. Results. In our studies, among 45 operated patients, 27 (60.0 %) had a diagnosis of axial hiatal hernia (type I), 9 (20.0 %) — paraesophageal hiatal hernia (type II), 8 (17.8 %) — combined hiatal hernia (type III), 1 (2.2 %) patient had hiatal hernia with a shortening of the esophagus (type IV). Grade I of hiatal hernia was noted in 25 (55.6 %) people, grade II occurred in 12 (26.7 %), and grade III, when body and even the antral part of the stomach prolapse into the posterior mediastinum, — in 8 (17.8 %) patients. Cruroplasty was performed in 100 % of cases: posterior — in 24 (53.3 %) individuals, anterior and posterior (сombined) — in 13 (28.9 %), alloplasty — in 8 (17.8 %). Laparoscopic fundoplication was carried out in all patients: Nissen fundoplication — in 36 (80.0 %), Toupet fundoplication — in 6 (13.3 %), Dor fundoplication — in 3 (6.7 %). There were no fatal cases. The average duration of surgery was (135 ± 24) min, the average time of transplant fixation — (24 ± 12) min. Conclusions. Therefore, laparoscopic antireflux operations are highly effective in the treatment of hiatal hernias, well tolerated and characterized by a low percentage of complications (6 (13.3 %) cases), rapid recovery of patients in the postoperative period, allowing them to be recognized as surgery of choice in the treatment of this pathology. The choice of surgical procedure for hiatal hernia is determined by the features of anatomical interrelations and the purpose of restoring the esophageal-gastric junction and diaphragm.