Surgical aspects of treatment of hiatal hernia

Abstract

Objective: enhancement the outcome of treatment of patients with complicated forms of hiatal hernia (HH) on the base on a devised personal complex approach.Materials and methods: the review was carried out of 204 patients with complicated forms of HH at the age of 17 to 77 years (men — 44%, women — 56.4%). All 204 patients suffered from gastroesophageal reflux disease (GERD). In 53 (26%) cases synthetic mesh implants were used during surgical management. In 38 patients (18.6%) with hiatal hernia and metaplasia of the esophageal mucosa (ESM) exposed to complex treatment, which includes antireflux surgical management and argon plasma coagulation (APC).Results: early postsurgical complications we met more oſten in the group of patients the ones we used mesh. Late postsurgical complications in the group of patients where mesh implants were used according to the indications were met less oſten. when assessing the quality of life according to the questionnaires GERD-HRqL and GSRS, the subjective symptoms of GERD decrease dramatically aſter surgical treatment (in 3 months), continue to decline up to 12 months, aſter which they acquire a constant character. In patients with hiatal hernia, which has become complicated by ESM metaplasia, aſter completing the courses of argonoplasmic coagulation, in all cases, complete regression of the metaplastic epithelium was registered by us.Conclusions: surgical management of complicated forms of HH using video laparoscopic technique based on the developed algorithm is highly effective, which is confirmed by the low quantity of postsurgical complications and a major improvement of the quality of life of patients.

Keywords

• hiatal hernia
• antireflux surgery
• mesh implants
• argon plasma coagulation