Minimally Invasive Surgery of Paraesophageal Hernias

Morales‐Conde, Salvador; Bernal, F. López; Alarcón, Isaías

doi:10.1007/978-3-030-55176-6_6

Cited by 3 publications

(3 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Основне завдання хірургічного лікування ГСОДкорекція анатомічних і фізіологічних порушень: усунення грижі, корекція антирефлюксної функції НСС, забезпечення вільного антеградного пасажу їжі [7]. Ефективність лікування становить 62-97 %, якість життя вірогідно поліпшується після антирефлюксного хірургічного лікування за результатами досліджень [2,3,8,9].…”

Section: вступunclassified

Diagnosis and surgical correction of insufficiency of physiological cardia in hiatal hernia

Shevchenkо

Prolom

Babii

et al. 2022

GASTRO

View full text Add to dashboard Cite

Background. 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. Materials and methods. 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. Results. 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. Conclusions. 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.

show abstract

Section: вступunclassified

Diagnosis and surgical correction of insufficiency of physiological cardia in hiatal hernia

Shevchenkо

Prolom

Babii

et al. 2022

GASTRO

View full text Add to dashboard Cite

show abstract

“…Методика Nissen, при якій дно шлунка на 360° обертається навколо внутрішньочеревного відділу стравоходу у вигляді манжети, є найбільш надійною і тому найбільш часто використовується (рис. 1А) [19,20,22]. У клінічній практиці найчастіше застосовується модифікація фундоплікації за Nissen, описана S. Rohr і співавт.…”

Section: вступunclassified

“…Рідше виконується фундоплікація за Toupet, при якій дно шлунка на 180° або 270° обертається навколо внутрішньочеревного відділу стравоходу по задній поверхні (рис. 1Б) [20][21][22].…”

Section: вступunclassified

1

Shevchenkо¹,

Prolom²,

Babii³

et al. 2021

GASTRO

View full text Add to dashboard Cite

The physiological incompetent cardia is a condition that is accompanied by reflux of gastric contents into the esophagus — gastroesophageal reflux disease, migration of a part of the stomach into the chest cavity — hiatal hernia. The main task of the surgical treatment of hiatal hernia is the correction of anatomical and physiological disorders: elimination of a hernia, correction of the antireflux function of the lower esophageal sphincter, and provision of the free antegrade passage of food. There is a large number of operations (more than 60 proposed methods) that are used in the surgical treatment of hiatal hernias, as well as gastroesophageal reflux disease. The article presents a method of surgical correction of the physiological incompetent cardia, ensures reliable restoration of the physiological cardia and preservation of the anatomical relationship of the diaphragm and the zone of the esophageal-gastric junction. It includes cruraphy and fundoplication. Cruraphy is performed with U-shaped sutures, which are placed on the right and left walls of the esophagus at the level of the cardia, with the crura of diaphragm fixed in them, corrugated sutures, which are applied to the medial pedicle of the diaphragm, reduce the esophageal opening of the diaphragm to the outer diameter of the esophagus and perpendicular to the axis of the esophagus as U-shaped sutures perform cardiogastric plication of the anterior wall of the stomach, followed by gastro-diaphragmopexy. The proposed method was used to treat 11 patients, the postoperative condition of the patients was satisfactory, without signs of postoperative dysphagic disorders. In all cases, good immediate and long-term results were obtained for a period of 6 months to 1 year. The use of the proposed method allows avoiding postoperative dysphagia and recurrence of the disease.

show abstract

Diagnosis and Surgical Correction of Anatomical and Topographic Changes in Case of Complicated Hiatal Hernias

Shevchenkо¹,

Prolom²,

Babii³

et al. 2022

Khark. Surg. Sch.

View full text Add to dashboard Cite

Resume. The aim of the study: improving the efficiency of surgical treatment for patients with hiatal hernia (HH) and HERD with reflux esophagitis through the development of a step-by-step method of surgical treatment aimed at saving and improving the anatomical and topographic solutions of the physiological cardia. Materials and methods. In 2017-2021, 78 patients with HH were examined and treated at the Department of Digestive Surgery of the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine, and in 16 (20, 8%) patients with HH in combination with GERD with reflux esophagitis. To confirm the diagnosis of HH and GERD, all patients undergo radiography, endoscopic examination, examination of pressure at the level of lower esophageal sphincter (LES). Results of the research. After the follow-up examination, found in 16 (20.8 %) patients with reflux esophagitis (in 3 (3.8 %) patients — esophageal ulcers). In 3 (3.8 %) patients with HH and GERD in combination with esophageal ulcer was treated in stages. The first stage of treatment was conservative therapy. After a course of therapy during endoscopic examination, esophageal stricture was detected. The second stage of treatment was balloon dilatation of the esophageal stricture. The third stage of treatment was antireflux surgery, which was performed in 78 (100 %) patients, in 11 (14.1 %) patients with HH, a new method of surgical correction of insufficiency of physiological cardia was proposed. Conclusions. The use of phased treatment of patients with HH and GERD with reflux esophagitis complicated by esophageal stricture and the proposed method of antireflux surgery ensures the elimination of pathological changes in HH, restores physiological cardia and preserves the anatomical relationship of the diaphragm and esophagus. In the postoperative period, the proposed method of surgical treatment reduces the likelihood of insufficiency of physiological cardia, dysphagia and recurrence of HH.

show abstract

Minimally Invasive Surgery of Paraesophageal Hernias

Cited by 3 publications

References 9 publications

Diagnosis and surgical correction of insufficiency of physiological cardia in hiatal hernia

Diagnosis and surgical correction of insufficiency of physiological cardia in hiatal hernia

1

Diagnosis and Surgical Correction of Anatomical and Topographic Changes in Case of Complicated Hiatal Hernias

Contact Info

Product

Resources

About