Causes of failures of known methods of antireflux laparoscopic interventions for hiatal hernias
| Autor: | B.F. Shevchenko, N.V. Prolom, O.M. Babii, S.O. Tarabarov, O.V. Simonova, O.V. Zeleniuk |
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| Jazyk: | English<br />Ukrainian |
| Rok vydání: | 2023 |
| Předmět: | |
| Zdroj: | Gastroenterologìa, Vol 57, Iss 1, Pp 35-42 (2023) |
| Druh dokumentu: | article |
| ISSN: | 2308-2097 2518-7880 |
| DOI: | 10.22141/2308-2097.57.1.2023.527 |
| Popis: | Background. The objective: to compare the effectiveness and safety of known laparoscopic antireflux interventions in the treatment of hiatal hernia and to detect the causes for their failure in a retrospective study. Materials and methods. In a retrospective comparative study, the long-term results of using the main methods of laparoscopic plastic surgery for hiatal hernias of various types and degrees were analyzed. Seventy-four (56.5 %) patients who underwent Nissen fundoplication were included in group 1. Group 2 consisted of 37 (28.2 %) people who underwent Toupet fundoplication and group 3 included 20 (15.3 %) patients who underwent Dor fundoplication. The study includes patients operated in the clinic of the institute over a 7-year period, with the possibility of clinical evaluation of long-term results and the exclusion of factors affecting the results of plastic surgery. All patients underwent X-ray and endoscopic examinations of the esophagus, stomach, duodenum, as well as manometry. Results. When analyzing the complaints of patients from groups 1–3 in the postoperative period, it can be noted that the most statistically significant indicators were dysphagia, regurgitation, cough, heartburn, bloating, stomach heaviness, pain behind the sternum (p 0.05, exact F test; 54.1 vs. 30.0 %, p > 0.05, exact F test; 37.8 vs. 30.0 %, p > 0.05, exact F test). Conclusions. 1. The number of patients who are unsatisfied with the results of surgery according to GERD-HRQL questionnaire, was 21.6 % ((11.0 ± 5.5) points) after Nissen fundoplication, 19.0 % ((19.0 ± 8.0) points) after Toupet fundoplication, and 15.0 % ((16.0 ± 7.3) points) after Dor fundoplication. 2. Failures of the known methods of antireflux laparoscopic interventions for hiatal hernia are associated with the destruction of the components of the physiological cardia and occurred in 40 (54.1 %) patients of group 1 (pylorospasm, dysphagia, dyspeptic disorders, reflux esophagitis, esophageal strictures), in 14 (37.8 %) in group 2 and in 6 (30.0 %) in the third group. 3. Nissen fundoplication in the postoperative period was significantly more often accompanied by dysphagia and pylorospasm compared to Toupet and Dor fundoplications (p |
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