Experience of performance of laparoscopic operations in patients, suffering hiatal hernias and gastroesophageal reflux disease

Abstract

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.