АНАЛИЗ ПОВТОРНЫХ ОПЕРАЦИЙ ПОСЛЕ ФУНДОПЛИКАЦИЙ

Abstract

The purpose: to present the experience of repeated laparoscopic operations after previously performed traditional and laparoscopic fundoplication for hiatal hernia and gastroesophageal reflux disease, to study the reasons for the unsatisfactory results of fundoplications. Materials and methods. This study presents the experience of repeated operations in 78 patients with recurrent hiatal hernia and gastroesophageal reflux disease in the period 2000-2023 (33 men and 45 women aged 21 to 75 years) who had previously undergone laparotomic (15) and laparoscopic (63) fundoplication ) way. Of these, 15 (19.3%) patients were initially operated in our clinic, 63 (80.7%) - in other medical institutions. Results. All 78 patients were reoperated by laparoscopic approach. There were no lethal cases. The examination and analysis of surgical findings revealed the following technical errors made during previous operations: due to an incorrectly formed fundoplication cuff, the fundoplication cuff migrated to the mediastinum (40), the fundoplication cuff was fixed to the stomach cardia (11), and there was an excessive narrowing of the hiatus due to crurorrhaphy ( 5), excessive compression of the esophagus by the cuff (6) and its complete absence (6), the "telescope" phenomenon (7), insufficient mobilization of the fundus of the stomach (13). In case of recurrence, repeated laparoscopic operations were performed: bringing down the fundoplication cuff from the mediastinum with mobilization of the shortened esophagus (50), repeated crurorrhaphy and laparoscopic fundoplication according to Nissen (14), dissection of the gastrosplenic ligament (13), anterior crurorrhaphy with a mesh prosthesis (1). Conclusions. The analysis of repeated laparoscopic antireflux operations showed that they are feasible and less safe than laparotomic ones, but carry a higher risk of complications compared to primary ones and should be performed by experienced surgeons using the same access as the primary operation. The variety of causes of failures and complications of antireflux operations, the technical complexity of repeated operations and the problematic nature of their good results determine the expediency of concentrating patients with hiatal hernia and gastroesophageal reflux disease in specialized hospitals. Laparoscopic revision antireflux surgeries are feasible and less safe than laparotomic ones, but carry a higher risk of complications compared to primary ones and should be performed by experienced surgeons using the same approach as the primary surgery.