Surgical correction of the physiological incompetent cardia in hiatal hernia

Abstract

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.

Keywords

• physiological incompetent cardia, hiatal hernia, laparoscopic fundoplication, cruraphy