Modern features of surgical treatment of esophageal hiatal hernias

Abstract

Diagnosis an esophageal hiatal hernia (EHH) is somewhat difficult, especially when this pathology is combined with other diseases of the abdominal cavity [1,2]. Treatment of gastroesophageal reflux diseases (GERD) can be both conservative and surgical [3], but conservative treatment does not eliminate this pathology [4]. According to many authors, even when resolving the issue of operative treatment of reflax, patients should undergo a preoperative course of conservative treatment of gastroesophageal reflux esophagitis [5]. However, there are also categorical messages regarding the earliest possible surgical intervention in the case of gastroesophageal reflux [6]. The aim Improvement of the results of surgical treatment of patients with EHH by performing combined surgical interventions.. Materials and methods. Esophagofundoplication and crurorrhaphy are the standard treatment for EHH. With increased gastric mobility, these interventions are supplemented with gastropexy and narrowing esophageal opening of the diaphragm operations. In order to effectively fix the stomach below the diaphragm, we offer the following techniques. With a stretched gastro-pancreatic ligament (9 patients), we isolate the last one, cut it off near the stomach and sew it to the cardiac part. With normal sizes of the gastro-pancreatic ligament, we use the phrenic-esophageal ligament (5 patients) for gastropexy, which we cross near the EHH, isolate it along its entire length, divide it into right and left leaflets, pass the left leaflet through the cardiac notch, and the right - through the left half of the lesser curvature of the stomach, after which both leaves are sewn to the tendinous part of the legs of the diaphragm. In the case of a paraesophageal hernia, when the lesser curvature of the stomach exits into the thoracic cavity (3 patients), we suggested fixing the last to the pre-prepared round ligament of the liver. Plastic surgery of the EHH is performed with the help of triangular and coronal ligaments, which are fixed to the connective tissue formations of the lateral parts of the EHH (7 patients). Results of the research. When using these methods, complications and relapses of the disease were not observed. The effectiveness of the proposed methods is explained by the reliable fixation of the stomach in the abdominal cavity with the help of natural anatomical formations, while the normal syntopic relations between the organs of the abdominal cavity are observed. Conclusion. Performing combined surgical interventions, during which the main factors of the pathogenesis of EHH are eliminated, allow to minimize the recurrence of the disease. References 1. Alice Sfara , Dan L Dumitrascu The management of hiatal hernia: an update on diagnosis and treatment. Med Pharm Rep. 2019 Oct; 92(4):321-325.doi: 10.15386/mpr-1323. Epub 2019 Oct 25. PMID: 31750430. 2. Olmi S, Cesana G, Gambioli A, Bonaldi M, Ferrari D, Uccelli M, Ciccarese F, Stefano C, Riccardo G, Lorenzo M. Effect of laparoscopic sleeve gastrectomy vs laparoscopic sleeve + Rossetti fundoplication on weight loss and de novo GERD in patients affected by morbid obesity: a randomized clinical study Obes Surg. 2022 May;32(5):1451-1458. doi: 10.1007/s11695-022-05955-8. Epub 2022 Feb 8. PMID: 35137287 3. Aiolfi A, Cavalli M, Sozzi A, Lombardo F, Mendogni P, Nosotti M, Bonitta G, Bruni PG, Campanelli G, Bona D. Paraesophageal hernia repair with laparoscopic Toupet fundoplication: impact on pulmonary function, respiratory symptoms and quality of life. Hernia. 2022 Dec;26(6):1679-1685. doi: 10.1007/s10029-022-02623-9. Epub 2022 May 16. PMID: 35578061. 4. Joachim Labenz. Conservative Therapy of Reflux Disease and its Limits. Zentralbl Chir. 2021 Apr;146(2):176-187. doi: 10.1055/a-1309-2368. Epub 2021 Feb 17. PMID: 33598907. 5. Runkel M, Kuvendjiska J, Marjanovic G, Fichtner-Feigl S, Diener MK. Ligamentum teres augmentation (LTA) for hiatal hernia repair after minimally invasive esophageal resection: a new use for an old structure Langenbecks Arch Surg. 2021 Nov;406(7):2521-2525. doi: 10.1007/s00423-021-02284-9. Epub 2021 Oct 6. PMID: 34611750. 6. Allman R, Speicher J, Rogers A, Ledbetter E, Oliver A, Iannettoni M, Anciano C. Fundic gastropexy for high risk of recurrence laparoscopic hiatal hernia repair and esophageal sphincter augmentation (LINX) improves outcomes without altering perioperative course. Surg Endosc. 2021 Jul;35(7):3998-4002. doi: 10.1007/s00464-020-07789-w. Epub 2020 Jul 17.PMID: 32681373.