Diagnosis of fundoplication cuff failure in patients operated by the Nissen method

The article is devoted to the treatment of patients with hiatal hernia. The aim of the study was to develop a method for diagnosing the failure of the fundoplication cuff in patients with recurrent hernia of the foodwater orifice of the diaphragm after Nissen fundoplication. The study included 42 patients. The first group consisted of 16 people with recurrent hiatal hernia. The second group consisted of 26 people without recurrence of hiatal hernia. When comparing groups of patients, a simple and objective sign of the failure of the fundoplication cuff after Nissen surgery is described.

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

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.

P6 HIATAL HERNIA REPAIR BY TENSION-FREE MESH CLOSURE OR SIMPLE SUTURING OF THE DIAPHRAGMATIC HIATUS

Aim To assess the anatomical and functional results of the use of a mesh for the repairing of hiatal hernia in patients with gastro-esophageal reflux disease (GERD) Background & Methods In hiatal hernia repair during antireflux surgery, less focus has traditionally been directed towards the restoration of the diaphragmatic hiatus. In other types of hernia repair, the use of a mesh-reinforced, tension-free technique has been shown to be associated with reduced recurrence rates. Patients (n=159) undergoing Nissen fundoplication for gastro-esophageal reflux disease were randomized to closure of the diaphragmatic hiatus with either crural sutures alone (n=77) or tension-free closure with a non-absorbable mesh (Crurasoft®, n=82). Primary outcome was radiologically verified recurrent hiatal hernia. Secondary outcomes were intra-and postoperative complications and courses, symptomatic recurrence, use of PPI, postoperative oesophageal acid exposure and Quality of Life. Results At 3 years recurrence rates were 12 % and 9 % in the mesh and suture groups respectively (p=0,61). Control of GERD symptoms, use of PPI and oesophageal acid exposure did not differ between groups. At the same time obstructive eating complaints were reduced in both groups compared to the preoperative setting (p<0.05) but more patients scored dysphagia for solid food after mesh closure (p=0,027). Quality of life scores were significantly improved throughout the follow up without differences between groups. Conclusion Tension-free crural repair with non-absorbable mesh does not reduce the incidence of recurrent hiatal hernia compared to crural sutures alone in GERD patients undergoing total fundoplication. This, together with the finding of increased dysphagia at 3 years postoperatively, suggests that mesh closure cannot be recommended for routine use in laparoscopic hiatal hernia repair for GERD.