Novosti
Khirurgii

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Year 2019 Vol. 27 No 5

EXCHANGE OF EXPERIENCE

A.F. CHERNOUSOV, T.V. KHOROBRYH, F.P. VETSHEV, V.I. KOROTKIY, N.M. ABDULKHAKIMOV, R.E. SALIKHOV

EXPERIENCE OF FUNDOPLICATION AND GASTROPLICATION IN TREATMENT OF REFLUX ESOPHAGITIS IN CARDIOFUNDAL, SUBTOTAL AND TOTAL HIATAL HERNIAS

I.M. Sechenov First Moscow State Medical University, Moscow,
The Russian Federation

Objective. To present the surgical treatment results of patients with cardiofundal, subtotal and total gastric hiatal hernias with a complete symmetric fundoplication or gastroplication cuff from the traditional and laparoscopic approaches.
Methods. Surgeries were performed in 81 patients with reflux esophagitis and cardiofundal, subtotal or total hiatal hernias. In the first group laparoscopy was conducted in 33 patients (fundoplication-11, gastroplication-22, posterior cruroraphy-23), laparotomy – in 48 patients (fundoplication – 8, gastroplication – 40, posterior cruroraphy – 28). The first group consisted of 30 women, the second one - 33.
Results. I – II degree complications according to the Clavien-Dindo classification were in 10 (12.3%) patients, treated conservatively. Surgical treatment was effective in all patients. 2 patients after laparoscopy required reoperation in the early postoperative period due to technical errors at the early stage of mastering the method. 1 patient after laparotomy required a reoperation due to the developed bleeding from the abdominal wall’s drainage orifice. Posterior cruroraphy was effective in all patients, regardless of the size of the hiatus. Surgical treatment, according to x-ray studies with contrast, despite the developed complications, was effective in all patients regardless of access in the early postoperative period.
Conclusions. A complete symmetric anti-reflux cuff effectively corrects reflux, regardless of its location above or below the diaphragm and regardless of the chosen access. The formation of a full symmetric anti-reflux cuff without fixing it to the legs of the diaphragm is the most appropriate and safe way. It is also necessary to remove the hernial sac from the posterior mediastinum. Correction of the diameter of the esophageal orifice with posterior cruroraphy without a mesh is effective in the treatment of cardiofundal, subtotal and total hiatal hernias.

Keywords: esophagus, diaphragm, hiatal hernia, gastroesophageal reflux disease, surgical treatment, fundoplication, cruroraphy
p. 586-594 of the original issue
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Address for correspondence:
119435, The Russian Federation,
Moscow, B. Pirogovskaya Str., 6, b.1,
I.M. Sechenov First Moscow
State Medical University,
Clinic of the Faculty Surgery
named after N.N. Burdenko,
Department of Faculty Surgery ¹1.
Tel. +7 906 068-38-12,
e-mail: dr.korotkiy@mail.ru,
Valentin I. Korotkiy
Information about the authors:
Chernousov Alexander F., MD, Professor, Academician of RAMS, Honored Scientist of the Russian Federation, Head of the Department of Faculty Surgery ¹1, the Clinic of the Faculty Surgery named after N.N. Burdenko, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-8792-1459
Khorobryh Tatiana V., MD, Professor of RAMS, Professor of the Department of faculty surgery ¹1, the Clinic of the Faculty Surgery named after N.N. Burdenko, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-5769-5091
Vetshev Fedor P., MD, Associate Professor, the Department of Faculty Surgery ¹1, the Clinic of the Faculty Surgery named after N.N. Burdenko, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-6589-092X
Korotkiy Valentin I., Surgeon, Post-Graduate, the Department of Faculty Surgery ¹1, the Clinic of the Faculty Surgery named after N.N. Burdenko, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-1359-5379
Abdulkhakimov Nuriddin M., Surgeon, Assistant, the Department of Faculty Surgery ¹1, the Clinic of the Faculty Surgery named after N.N. Burdenko, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-8324-2376
Salikhov Rashad, 6-year Student, the Department of Faculty Surgery ¹1, the Clinic of the Faculty Surgery named after N.N. Burdenko, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-1090-2123
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