Erratum to: Paraesophageal Hernia and Reflux Prevention: Is One Fundoplication Better than the Other?

Andolfi, Ciro; Plana, Alejandro; Furno, Sara; Fisichella, P. Marco

doi:10.1007/s00268-017-4062-z

Cited by 2 publications

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“…Діагностика ГСОД ґрунтується на клінічній картині та інструментальних методах дослідження. Інструментальні методи дослідження, які використовуються для діагностики ГСОД, включають рентгенологічне дослідження, езофагогастроскопію, добову рН-метрію стравоходу і шлунка [4][5][6]. Під час рентгенологічного дослідження стравоходу і шлунка виявляють власне ГСОД, оцінюють її розміри, фіксацію, а також моторику…”

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Ключові слова: неспроможність фізіологічної кардії; грижа стравохідного отвору діафрагми; ендосонографія; еластометрія

ВступГрижі стравохідного отвору діафрагми (ГСОД) за поширеністю займають одне з провідних місць у сучасній гастроентерології, перебуваючи в структурі захворювань шлунково-кишкового тракту на другому-третьому місцях, конкуруючи з такими захворюваннями, як хронічний холецистит і виразкова хвороба шлунка та дванадцятипалої кишки (ДПК) [1-3].Діагностика ГСОД ґрунтується на клінічній картині та інструментальних методах дослідження. Інструментальні методи дослідження, які використовуються для діагностики ГСОД, включають рентгенологічне дослідження, езофагогастроскопію, добову рН-метрію стравоходу і шлунка [4][5][6]. Під час рентгенологічного дослідження стравоходу і шлунка виявляють власне ГСОД, оцінюють її розміри, фіксацію, а також моторику

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The role of endoscopic ultrasound in assessment of physiological cardia insufficiency during diagnosis of hiatal hernia

Shevchenko,

Babii,

Prolom

et al. 2024

GASTRO

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Background. The aim of the study: to determine the role of endoscopic ultrasound (EUS) in assessing the failure of the physiological cardia in the diagnosis of hiatal hernias (HH). Materials and methods. At the Department of Digestive Surgery of the State Institution “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine” in 2023, we have performed surgical treatment of 33 patients with HH: axial HH were diagnosed in 21 (63.6 %) cases (I type), paraesophageal HH — in 12 (36.4 %) patients (II type) (ICD-10 code is K44). Control group included 20 practically healthy people. Results. All patients underwent an X-ray and endoscopic examination of the esophagus, stomach, duodenum, and EUS. All 33 (100.0 %) patients underwent an X-ray to confirm the diagnosis and an endoscopic examination to detect changes in the esophageal mucosa. EUS was performed in 31 (93.9 %) patients. The thickness of the esophageal wall was assessed using EUS, which made it possible to determine the state of the structures of the physiological cardia in HH: the displacement of part of the stomach above the diaphragm, location of the gastroesophageal junction relative to the legs of the diaphragm and relative to each other; the distance between the legs of the diaphragm (area of the HH) and their length; the cross-sectional area of the HH (hernial sac). The data obtained during EUS influenced the choice of the method for surgical correction of the physiological cardia with HH. Conclusions. Thus, with HH, EUS makes it possible to evaluate pathological changes of the main structures in the failure of the physiological cardia, to improve diagnosis for the types of HH, the location of the gastroesophageal junction, with determination of dimensions of the esophageal hiatus, the distance between the legs of the physiological cardia, localization and cross-section of the hernial sac, which influenced the choice of the surgery for physiological cardia in HH.

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The role of endoscopic ultrasound in assessment of physiological cardia insufficiency during diagnosis of hiatal hernia

Shevchenko,

Babii,

Prolom

et al. 2024

GASTRO

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“…На сьогодні у світі розроблено й запроваджено низку хірургічних лікувальних стратегій при ГСОД, що направлені на корекцію анатомічних і фізіологічних порушень: усунення грижі, корекцію антирефлюксної функції кардії завдяки фундоплікації і крурорафії, забезпечення вільного пасажу їжі [4,5]. Враховуючи, що лапароскопічні втручання значно зменшують операційну травму, тривалість оперативних втручань і частоту операційних ускладнень, операції з приводу ГСОД проводять цим способом [6,7].…”

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“…C. Andolfi та співавт. (2017) було проведено огляд досліджень, який доводить, що найбільш часто використовували фундоплікацію за Nissen або Nissen-Rossetti, тоді як часткова фундоплікація (Toupet частіше, ніж Dor) виконувалася у пацієнтів із порушенням моторики стравоходу або не виконувалася зовсім [5].…”

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Causes of failures of known methods of antireflux laparoscopic interventions for hiatal hernias

Shevchenkо

Prolom

Babii

et al. 2023

GASTRO

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Background. The objective: to compare the effectiveness and safety of known laparoscopic antireflux interventions in the treatment of hiatal hernia and to detect the causes for their failure in a retrospective study. Materials and methods. In a retrospective comparative study, the long-term results of using the main methods of laparoscopic plastic surgery for hiatal hernias of various types and degrees were analyzed. Seventy-four (56.5 %) patients who underwent Nissen fundoplication were included in group 1. Group 2 consisted of 37 (28.2 %) people who underwent Toupet fundoplication and group 3 included 20 (15.3 %) patients who underwent Dor fundoplication. The study includes patients operated in the clinic of the institute over a 7-year period, with the possibility of clinical evaluation of long-term results and the exclusion of factors affecting the results of plastic surgery. All patients underwent X-ray and endoscopic examinations of the esophagus, stomach, duodenum, as well as manometry. Results. When analyzing the complaints of patients from groups 1–3 in the postoperative period, it can be noted that the most statistically significant indicators were dysphagia, regurgitation, cough, heartburn, bloating, stomach heaviness, pain behind the sternum (p < 0.05, exact F test). During endoscopic examination, reflux esophagitis was detected in 16 (21.6 %) patients of group 1, in 7 (18.9 %) of group 2, and in 2 (10.0 %) patients of group 3. Erosions of the lower third of the esophagus were found in 14 (18.9 %) patients from group 1, in 6 (16.2 %) from group 2, and in 2 (10.0 %) patients from group 3. Esophageal stricture was detected in 1 (1.4 %) patient from group 1 in the postoperative period during endoscopic examination. Signs of a “second entrance” to the stomach were found in 16 (13.5 %) patients of group 1, in 5 (13.5 %) of group 2, and in 2 (10.0 %) of group 3. Dislocation of the fundoplication cuff was noted in 1 (1.3 %) patient of group 1, resulting in deformation of the esophagogastric junction and pain syndrome. Pylorospasm was found in 8 (8.8 %) patients from group 1, in 3 (2.9 %) from group 2 and in 1 (5.0 %) patient from group 3. During the X-ray examination, recurrent hiatal hernia was detected: in group 1 — in 10 (13.5 %) cases, in group 2 — in 5 (13.5 %), in group 3 — in 2 (10.0 %). When assessing the quality of life of patients after surgical interventions, it was found that in group 1, the average score on the Gastroesophageal Reflux Disease — Health-Related Quality of Life (GERD-HRQL) questionnaire was (11.0 ± 5.5 (3–35) points, in group 2 — (19.0 ± 8.0 (3–35)), in group 3 — (16.0 ± 7.3 (3–35)) points, which was quite high in all groups. The distribution of satisfaction with the condition in group 1 was as follows: satisfied — 34 (45.9 %) patients, partially satisfied — 24 (32.4 %), unsatisfied — 16 (21.6 %). The distribution of satisfaction with the condition in group 2 was as follows: satisfied — 16 (43.2 %) patients, partially satisfied — 14 (37.8 %), unsatisfied — 7 (19.0 %). The distribution of satisfaction with the condition in group 3 was as follows: satisfied — 9 (45.0 %) patients, partially satisfied — 8 (40.0 %), unsatisfied — 3 (15.0 %). In the distant postoperative period, complications (pylorospasm, dysphagia, dyspeptic disorders, reflux esophagitis, esophageal strictures) occurred in 40 (54.1 %) patients of group 1, in 14 (37.8 %) of group 2, and in 6 (30.0 %) of group 3. There were no significant differences in the frequency of postoperative complications between groups (54.1 vs. 37.8 %, p > 0.05, exact F test; 54.1 vs. 30.0 %, p > 0.05, exact F test; 37.8 vs. 30.0 %, p > 0.05, exact F test). Conclusions. 1. The number of patients who are unsatisfied with the results of surgery according to GERD-HRQL questionnaire, was 21.6 % ((11.0 ± 5.5) points) after Nissen fundoplication, 19.0 % ((19.0 ± 8.0) points) after Toupet fundoplication, and 15.0 % ((16.0 ± 7.3) points) after Dor fundoplication. 2. Failures of the known methods of antireflux laparoscopic interventions for hiatal hernia are associated with the destruction of the components of the physiological cardia and occurred in 40 (54.1 %) patients of group 1 (pylorospasm, dysphagia, dyspeptic disorders, reflux esophagitis, esophageal strictures), in 14 (37.8 %) in group 2 and in 6 (30.0 %) in the third group. 3. Nissen fundoplication in the postoperative period was significantly more often accompanied by dysphagia and pylorospasm compared to Toupet and Dor fundoplications (p < 0.05).

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Erratum to: Paraesophageal Hernia and Reflux Prevention: Is One Fundoplication Better than the Other?

Cited by 2 publications

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The role of endoscopic ultrasound in assessment of physiological cardia insufficiency during diagnosis of hiatal hernia

The role of endoscopic ultrasound in assessment of physiological cardia insufficiency during diagnosis of hiatal hernia

Causes of failures of known methods of antireflux laparoscopic interventions for hiatal hernias

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