[Surgical treatment of hiatal hernia complicated by short esophagus: a prospective study].

Autor:	Sovpel IV; Gorky Donetsk National Medical University, Donetsk, Russia.; Professor Bondar Republican Cancer Center, Donetsk, Russia., Sedakov IE; Gorky Donetsk National Medical University, Donetsk, Russia.; Professor Bondar Republican Cancer Center, Donetsk, Russia., Sovpel OV; Gorky Donetsk National Medical University, Donetsk, Russia.; Professor Bondar Republican Cancer Center, Donetsk, Russia., Shapovalova YA; Gorky Donetsk National Medical University, Donetsk, Russia.; Professor Bondar Republican Cancer Center, Donetsk, Russia., Balaban VV; Sechenov First Moscow State Medical University, Moscow, Russia.
Jazyk:	ruština
Zdroj:	Khirurgiia [Khirurgiia (Mosk)] 2023 (5), pp. 31-38.
DOI:	10.17116/hirurgia202305131
Abstrakt:	Objective: To analyze immediate and long-term postoperative results in patients with hiatal hernia complicated by short esophagus. Material and Methods: We prospectively analyzed postoperative outcomes in 113 patients with hiatal hernia who underwent surgery between 2013 and 2021. The main group consisted of 54 patients with length of intra-abdominal segment of esophagus <4 cm who underwent Collis procedure or esophagus >4 cm and indications for Nissen fundoplication cuff. The control group consisted of 59 patients and indications for esophageal lengthening procedure only if length of intra-abdominal segment of esophagus was less than 2 cm. This surgery was started with anterolateral vagotomy, and Collis procedure was performed in case of ineffective vagotomy. Nissen fundoplication was performed for abdominal segment of esophagus >2 cm. Results: In the main group, 17 (31.5%) patients with intra-abdominal segment of esophagus <4 cm required Collis procedure. In the control group, length of intra-abdominal segment of esophagus <2 cm was observed in 6 (10.2%) patients. In all cases, anterolateral vagotomy was performed. Surgery time was 189 (80-290) and 136 (90-320) min, respectively ( p =0.001). Postoperative complications in the main group occurred in 8 (14.8%) patients, in the control group - 4 (6.8%) patients ( p =0.281). One (1.7%) patient died in the control group. The follow-up period was 38 (12-66) months. In long-term period, recurrence developed in 2 (3.7%) and 11 (20%) patients, respectively ( p =0.026). High satisfaction with postoperative outcomes was observed in 51 (94.4%) and 46 (79.3%) patients, respectively ( p =0.038). Conclusion: Uncorrected shortening of the esophagus can be one of the main risk factors of recurrence in long-term period. Expanding the indications for Collis gastroplasty can reduce the incidence of poor outcomes without affecting the incidence of postoperative complications.
Databáze:	MEDLINE
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