scholarly journals Recurrent hiatal hernias. To operate or not?

2020 ◽  
Vol 11 (5) ◽  
pp. 31-35
Author(s):  
Dmitry I. Vasilevsky ◽  
Georgy T. Bechvaya ◽  
Akhmat M. Ahmatov ◽  
Andrey Yu. Korolkov ◽  
Alexander A. Smirnov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hiatal Hernia ◽  
Recurrent Hernia ◽  
Initial Position ◽  
Long Term Results ◽  
Prosthetic Material ◽  
Scientific Discussion ◽  
Abdominal Organs ◽  
Treatment Indications ◽  
Functional Factors

The recurrence of a hiatal hernia after surgical treatment is the most serious and far from resolved problem in this area of surgery. The validity and effectiveness of surgical treatment of recurrent hiatal hernia of the diaphragm remains the subject of clinical research and scientific discussion. The main problems of such interventions are the difficulty of eliminating the anatomical or functional factors that underlie the failure of the primary operation. The stated provisions determine the need for further searches for a solution of this problem. In the period from 2015 to 2020, 61 patients with recurrent hernia of the gastrointestinal orifice of the diaphragm underwent surgical treatment. Indications for the operation were gastroesophageal reflux refractory to drug therapy or anatomical changes that carry the risk of developing life-threatening conditions. In 58 (95.1%) cases, surgery was performed laparoscopically, in 3 (4.9%) through left-side thoracotomy. In 54 (88.5%) cases, complete restoration of normal anatomy with closure of the hiatal opening with prosthetic material is performed. In 7 (11.5%) cases, when the esophagus was shortened, the fundoplication cuff was created in the chest cavity, and the hiatal opening was performed only with its own tissues. Complications occurred in 11 (18.0%) cases (7 pneumothorax, 2 bleeding, 2 perforation of a hollow organ). Long-term results (12-48 months) were evaluated in 57 (93.4% of operated) people. Repeated recurrence of hiatal hernia of the diaphragm was detected in 6 (10.5%) cases. In 44 (77.2%) cases, the natural anatomical position of the abdominal organs was documented. In 7 (12.3%) patients, with a fundoplication cuff formed in the chest, its initial position was ascertained.

scholarly journals АЛГОРИТМ ДИАГНОСТИКИ И ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ БОЛЬНЫХ ЖКБ, СОЧЕТАННОЙ С ГАСТРОЭЗОФАГЕАЛЬНОЙ РЕФЛЮКСНОЙ БОЛЕЗНЬЮ И ГРЫЖЕЙ ПИЩЕВОДНОГО ОТВЕРСТИЯ ДИАФРАГМЫ

World Science ◽  
2020 ◽  
Vol 2 (3(55)) ◽  
pp. 21-30
Author(s):  
Велигоцкий А. Н. ◽  
Рыбак И. М. ◽  
Страховецкий В. С. ◽  
Леонов А. В. ◽  
Федоровский С. Г. ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Hiatal Hernia ◽  
Reflux Disease ◽  
Calculation Method ◽  
Long Term Results ◽  
Original Formula

The results of examination and surgical treatment of 36 patients with cholelithiasis in combination with a hiatal hernia according to the developed algorithm, who were hospitalized and operated on in the clinic from 2014 to 2019, are presented. analysis of the early and long-term results of surgical treatment, it is proved that the surgical treatment of patients with cholelithiasis combined with gastroesophageal reflux disease and hiatal hernia is improved. In practice, the choice of tactics is carried out by the calculation method using the original formula. Thanks to the studies, it was possible to optimize the tactics of surgical treatment of patients with combined pathology.

scholarly journals Principles of surgical treatment of recurrent hiatal hernias (review of literature)

2020 ◽  
Vol 26 (3) ◽  
pp. 20-24
Author(s):  
G. T. Bechvaya ◽  
D. I. Vasilevsky ◽  
A. M. Ahmatov ◽  
V. V. Kovalik
Keyword(s):  
Surgical Treatment ◽  
Gastroesophageal Reflux ◽  
Motor Skills ◽  
Surgical Interventions ◽  
Large Size ◽  
Abdominal Organs ◽  
Alternative Approach ◽  
Treatment Indications ◽  
Life Threatening ◽  
Recurrent Hiatal Hernia

Recurrent hiatal hernia is the re-displacement of the abdominal organs into the chest after surgical treatment. Indications for repeated surgical interventions for this pathology are resistant to medical correction gastroesophageal reflux or anatomical disorders, bearing the risk of developing life-threatening conditions. The key task of revision interventions is to identify and address the causes of the failure of the primary operation. The main factors of the recurrence of hernias of this localization are the large size of the hiatal opening, the mechanical weakness of the legs of the diaphragm and the shortening of the esophagus. To increase the reliability of the esophageal aperture plasty in the surgical treatment of recurrent hiatal hernias, prosthetic materials are widely used. When the esophagus is shortened, it is possible to increase its length by creating a gastric stalk (gastroplasty) or fixing the stomach to the anterior abdominal wall (gastropexy). The disadvantage of both methods is the occurring functional impairment. An alternative approach is the formation of a fundoplication wrap in the chest with the closure of the esophageal opening only with its own tissues. To eliminate or prevent the development of gastroesophageal reflux, antireflux reconstruction is an essential component of operations for recurrent hiatal hernias. The option of fundoplication is selected in accordance with the contractility of the esophagus. With normokinesia, circular fundoplication was preferred, with impaired motor skills – free reconstructions.

scholarly journals SURGICAL TREATMENT OF RECURRENT HIATAL HERNIAS

2019 ◽  
Vol 178 (5) ◽  
pp. 69-73
Author(s):  
D. I. Vasilevsky ◽  
G. T. Bechvaya ◽  
A. M. Ahmatov
Keyword(s):  
Surgical Treatment ◽  
Hiatal Hernia ◽  
High Frequency ◽  
Common Type ◽  
Long Term Results ◽  
Revision Operation ◽  
Surgical Interventions ◽  
The People ◽  
Visceral Anatomy

OBJECTIVE. Hiatal hernias are the most common type of visceral anatomy disorder. The unresolved problem of surgical treatment of this pathology remains the high frequency of its relapse. Currently, it is believed that repeated surgical interventions for hiatal hernia are technically difficult, carry a high risk of complications and have unsatisfactory long-term results.MATERIAL AND METHODS. In the period from 2015 to 2019, 55 patients with this pathology were operated. In 52 (94.5 %) cases, the revision operation was performed laparoscopically, in 3 (5.5 %) – through left-side thoracotomy. The technique of the operation implied the removal of hiatal hernia and the implementation of antireflux reconstruction. In five (9.9 %) patients with a shortened esophagus, the fundoplication wrap was originally created in the chest; in 50 (90.1 %), normal anatomy was restored.RESULTS. Long-term results ranging from 12 to 48 months were evaluated in 53 (96.4 %) cases. The natural position of the esophagus and stomach in relation to the diaphragm was detected in 43 (81.1 %) patients, relapse of hiatal hernia – in 5 (9.4 %). In 5 patients, the fundoplication wrap formed in the chest was functional. The absence of gastroesophageal reflux was observed in 41 (91.8 % of patients who had GERD before surgery). In 4 (8.8 %) cases, including one patient with antireflux reconstruction in the chest, a relapse of the disease occurred.CONCLUSION. The presented results allowed the surgical treatment of recurrent hiatal hernias reasonable and effective.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

scholarly journals Causes of unsuccessful surgical treatment of hiatal hernia

2020 ◽  
Vol 11 (2) ◽  
pp. 67-72
Author(s):  
Georgy T. Bechvaya ◽  
Akhmat M. Ahmatov ◽  
Dmitry I. Vasilevsky ◽  
Vladislav V. Kovalik
Keyword(s):  
Surgical Treatment ◽  
Hiatal Hernia ◽  
Disease Recurrence ◽  
High Rate ◽  
Technical Errors ◽  
Large Size ◽  
Abdominal Organs ◽  
Life Threatening ◽  
Visceral Anatomy ◽  
The Relationship

Hiatal hernia is the most common type of visceral anatomy disorder, observed in people under 30 years of age in 10%, older than 50 years in 60%. Four types of hiatal hernias (IIV) are distinguished by the variant of the disturbances in the relationship between the esophagus, stomach, and diaphragm. Indications for surgical treatment of hiatal hernias are gastroesophageal reflux or anatomical disorders, which have a risk of developing life-threatening conditions (obstruction or necrosis of the stomach). An unresolved problem in this part of surgery is the high rate of disease recurrence, reaching 1015 4060%. The subjective reasons for the unsatisfactory results of surgical treatment of this pathology include technical errors in performing interventions (insufficient mobilization of the esophagus, stomach, legs of the diaphragm, incomplete excision of the hernial sac) and flaws in perioperative support (insufficient analgesia, vomiting, cough). The objective factors of the repeated displacement of the abdominal organs into the chest are the large size of the hiatal opening (more than 5 cm in maximum dimension), the insufficient mechanical strength of the legs of the diaphragm (hypotrophy, fibrosis) and the shortening of the esophagus (reduction of the abdominal part length less than 5 cm). Each of the noted factors plays a own role, together determining the success or failure of the surgical intervention. Understanding the basic principles and unresolved issues in this field of surgery is a prerequisite for its further development.

scholarly journals ROLE AND PLACE OF ULTRASONOGRAPHY IN DIAGNOSTICS OF ADHESIVE INTESTINAL OBSTRUCTION

2020 ◽  
Vol 73 (1) ◽  
pp. 83-86
Author(s):  
Vadim B. Borisenko ◽  
Artem N. Kovalev ◽  
Tatyana А. Denysiuk
Keyword(s):  
Surgical Treatment ◽  
Intestinal Obstruction ◽  
Conservative Therapy ◽  
Ray Method ◽  
Transabdominal Ultrasonography ◽  
X Ray ◽  
Abdominal Organs ◽  
Ultrasound Study ◽  
Treatment Indications ◽  
Adhesive Intestinal Obstruction

The aim: To study the possibilities of ultrasound in adhesive ileus obstruction diagnosis and indications for surgical treatment determination. Materials and methods: The results of diagnosis and treatment of 60 patients with acute adhesive intestinal obstruction with comparative use of X-ray and ultrasound methods were analyzed. Results: The use of a standard X-ray examination of the abdominal organs upon admission to the hospital allowed the diagnosis of acute adhesions of small bowel obstruction in only 32 (53.3%) patients. Transabdominal ultrasonography allowed the establishment of adhesive ileus during hospitalization in 53 (88.3%) patients and also in 7 (11.7%) during a dynamic examination 2-3 hours after admission. Due to the lack of positive effect from the conducted conservative therapy relying on the data of ultrasound studies, 33 (55%) patients were operated on. During X-ray examination, only 10 (30.3%) of these patients demonstrated negative X-ray dynamics, and with an ultrasound study, deterioration of echo pictures was observed in all 33 (100%) patients. Conclusions: Compared with the X-ray method, transabdominal ultrasonography is established to be safe, affordable, simpler, non-invasive and highly informative method for the study of acute adhesions of the small intestinal obstruction. The method allows the assessment of the ongoing conservative therapy dynamics and determination for surgical treatment indications.

Temporary “liquid” Implant for Congenital Glaucoma (long-term results)

2020 ◽  
pp. 49-65
Author(s):  
N Bobrova ◽  
N Trofimova
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Hypotensive Effect ◽  
Congenital Glaucoma ◽  
Long Term Results ◽  
General Will ◽  
Visual Functions ◽  
Advanced Stages ◽  
Intraocular Fluid

The aim of the work was to analyze the long-term results of using a temporary “liquid” implant in the surgery of congenital glaucoma in children. The basis of the developed method of filtrative antiglaucomatous surgery (Patent of Ukraine No. 45099 of 2009) – viscosinusotrabeculotomy – has been set the task of reducing the risk of developing intra- and postoperative complications, reducing the scarring rate and maintaining the newly created ways of the intraocular fluid outflow, which in general will increase the effectiveness of surgical treatment of congenital glaucoma in children. 54 children (91 eyes) with simple congenital glaucoma at the age of 1 to 36 months were operated on average (8.7 ± 8.2) months. The persistent and long-lasting hypotensive effect achieved due to viscosinusotrabeculotomy in children with developed and far-advanced stages of congenital glaucoma stops the processes of stretching of the membranes of the eye and stabilizes their size, which in general allows preserving and visual functions improving, in infancy – creating conditions for their formation.

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