@article{Shevchenko_Prolom_Babii_Zeleniuk_Tarabarov_Galinsky_2022, title={Diagnosis and surgical correction of insufficiency of physiological cardia in hiatal hernia}, volume={56}, url={https://gastro.zaslavsky.com.ua/index.php/journal/article/view/487}, DOI={10.22141/2308-2097.56.1.2022.487}, abstractNote={<p><strong>Background.</strong> The purpose of the study was to improve the diagnosis and improving the results of surgical treatment of patients with hiatal hernia (HH) and GERD by applying the develo­ped method of surgical correction of insufficiency of physiological cardia aimed at preserving and restoring the anatomical and topographic relationships of the esophagocardial organs. <strong>Materials and methods.</strong> In the Department of Digestive Surgery of the State Institution “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine” for the period 2017–2021 conducted a study in 78 patients with HH, including: axial HH (type I) was 60 (77.0 %) patients; paraesophageal (type II) — 9 (11.5 %) patients; mixed (type III) — 9 (11.5 %) (code for ICD-10 — K 44). To establish and confirm the diagnosis, patients underwent radiological and endoscopic examination of the esophagus, stomach, duodenum, manometry. <strong>Results.</strong> In the analysis of complaints of examined patients it can be noted that the most common clinical manifestations in patients with HH and GERD were heartburn in 73 (93.7 %), belching in 68 (87.2 %) and epigastric pain in 64 (82.0 %). The erosions of the lower third of the esophagus was found in 13 (16.7 %) patients, while according to the Los Angeles classification in 6 (7.7 %) patients had esophagitis grade A, 7 (8.9 %) patients — grade B. According to the results of the mano­metry study, the highest pressure was observed in patients with axial HH and was (13.54 ± 3.32) mm Hg, and the lowest — in patients with GERD and was (9.81 ± 3.18) mm Hg. After a comprehensive examination, 3 (3.8 %) patients after confirmation of the diagnosis of HH in combination with Barrett’s esophagus underwent two-stage treatment: the first stage performed argonoplasmic ablation of altered esophageal mucosa, the second stage — antireflux surgery. All of 78 (100 %) patients underwent antireflux surgery. Laparoscopic fundoplications were performed: the Nissen fundoplication was performed in 53 (67.9 %) patients, Toupet fundoplication in 7 (8.9 %) patients and Dor fundoplication in 5 (6.6 %) patients, cruroraphy was performed in 100.0 %. The 11 (14.1 %) patients underwent surgery according to a new method that provides reliable restoration of physiological cardia and preservation of the anatomical relationship of the diaphragm and esophageal-gastric junction and includes cruroraphy and fundoplication. <strong>Conclusions.</strong> The method of surgical treatment of insufficiency of physiological cardia in HH, proposed by us, aimed at the correction of physiological cardia is less traumatic than known, provides a reliable restoration of the anatomical relationship of the esophagogastric region.</p>}, number={1}, journal={GASTROENTEROLOGY}, author={Shevchenko, B.F. and Prolom, N.V. and Babii, O.M. and Zeleniuk, O.V. and Tarabarov, S.O. and Galinsky, O.O.}, year={2022}, month={May}, pages={48–53} }