Experience of performance of laparoscopic operations in patients, suffering hiatal hernias and gastroesophageal reflux disease
Objective. Аnalysis of results of surgical treatment in patients, suffering hiatal hernias (HH) and gastroesophageal reflux disease (GERD).
Маterials and methods. Results of treatment were analyzed in 245 patients, suffering HH and GERD, оperated on in clinic of surgery and endoscopy of the Faculty of Postgraduate Education University in 2004 - 2018 yrs. There were 114 women, men - 131, average age of patients have constituted (49 ± 3.18) yrs, average body mass index – 32.9 kg/m2.
While doing examination for HH and GERD the patients’ symptoms were analyzed, as well as the disease anamnesis, еsophagogastroduodenoscopy was performed, roentgenoscopy of the gut and thoracic cavity organs, ambulatory esophageal рН-monitoring was conducted, the calcium content in saliva was determined. For standardized questioning and interview of patients the Likert questionnaire, DeMeester scale and the Gastro Intestinal Quality of Life Index were calculated. Esophageal changes, caused by refluxesophagitis, were depicted in accordance to Los-Angeles classification (1994).
Results. HH was diagnosed in 229 (93.5%) patients: axial one - in 203 (88.6%), paraesophageal - in 3 (1.3%), mixed - in 23 (10.0%). GERD was revealed in 93.1% patients. In 170 (69.4%) patients Nissen laparoscopic fundoplication was performed, in 24 (9.8%) – Toupet fundoplication, in 51 (20.8%) – Nissen fundoplication in own modification (Pat. N 59772). The operation duration have constituted (90 ± 25) min at average. In the learning period for procedure the intraoperative complication (damage of spleen with hemorrhage) was registered in 3 (1.2%) patients. Postoperative period was complicated by pneumothorax in 2 (0.8%) patients.
Conclusion. For prevention of the disease recurrence such risk factors must be taken into account, as the HH type and size, mobilization and excision of hernial sac, selection of hernioplasty and fundoplication method, presence of obesity and the GERD complications. Correct choice of the operative treatment type and adequate volume of the operation makes possible the results of treatment improvement in patients, suffering HH and GERD.
2. Huberhryts NB, Lukashnvych HM, Holubova OA. Hryzhy pyshchevodnoho otverstvyya dyafrahmy: sovremennye predstavlenyya o patoheneze y lechenyy Suchasna hastroenterolohiya. 2012; 3(65):105-13. [In Ukrainian].
3. Stefanidis D, Hope WW, Kohn GP. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc. 2010;24(11):2647-69. doi:10.1007/s00464-010-1267-8.
4. Reva VB. Topohrafo-anatomichne obgruntuvannya plastyky diafrahmy z pryvodu diafrahmal'nykh hryzh. Klin anat ta oper khirurhiya. 2003;2(1):41-5. [In Ukrainian].
5. Tovkach YuV. Suchasni tekhnolohiyi v khirurhichnomu likuvanni gastroesophageal'noyi reflyuksnoyi khvoroby Klinichna ta eksperymental'na patolohiya. 2013;1(43):194-6 [In Ukrainian].
6. Rosenthal R, Peterli R, Guenin MO, von Flue M, Ackermann C. Laparoscopic antireflux surgery: long-term outcomes and quality of life. J Laparoendosc Adv Surg Tech A. 2006;16:557-61. doi:10.1111/j.1600-6143.2011.03984.x.
7. Anvari M, Allen C, Marshall J, Armstrong D, Goeree R, Ungar W, Goldsmith C. A randomized controlled trial of laparoscopic nissen fundoplication versus proton pump inhibitors for treatment of patients with chronic gastroesophageal reflux disease: One-year follow-up. Surg Innov. 2006;13:238-49. doi:10.1177/1553350606296389.
8. Champion JK. Thoracoscopic Belsey fundoplication with 5-year outcomes. Surg Endosc. 2003;17:1212-5. doi:10.1007/s00464-010-1267-8.
9. Zacharoulis D, O’Boyle CJ, Sedman PC, Brough WA, Royston CM. Laparoscopic fundoplication: a 10-year learning curve. Surg Endosc. 2006; 20:1662-70. doi:10.1007/s00464-010-1104-0.
10. Lapach SN, Chubenko AV, Babich PN. Statistical methods in medical - biological studies using Excel. Kyiv: «Morion»; 2000. 315 s. [In Ukrainian].
11. Stylopoulos N, Gazelle GS, Rattner DW. Paraesophageal hernias: operation or observation? Ann Surg. 2002;236:492-500; discussion 500-491. doi: 10.1007/s00464-013-3173-3.
12. Stadlhuber RJ, Sherif AEl, Mittal SK, Fitzgibbons RJ. Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surgical endoscopy. 2009;23(6):1219-26. doi:10.1007/s00464-008-0205-5.
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