Comparative analysis of the results of reconstruction of the cardioesophageal transition of the liver round connection and fundoplication by the Nissen–Rosetti method in treatment of hernias

Abstract

The paper presents a comparative characteristic of the results of surgical treatment of 27 patients with hiatal hernias using the Rampal–Narbona cardiorespexy technique and 16 patients who underwent laparoscopic Nissen– Rosetti fundoplication with cruroraphy. Cardioterespexy according to the Rampal-Narbona technique consists in the use of lig. Teres hepatis with the aim of forming the angle of His, fixing the cardiac part of the stomach and esophagus in the abdominal cavity. There were no cases of mortality. Complications after surgery were observed in older patients who were associated with concomitant pathology. The patients were examined within 10 to 18 months after surgery; in both groups, several cases of relapses and complications were recorded. In percentage terms, these data are as follows: during cardioterespexia surgery, the recurrence rate was 3.7%, signs of esophagitis were observed in 18%, cardia insufficiency was observed in 11.1%, signs of GER were in 11.1%, while in patients, of those operated on according to the Nissen–Rosetti technique, similar indicators were somewhat different: the percentage of relapse was 6.25%, signs of esophagitis were observed in 18.75%, cardiac insufficiency was observed in 18.75%, signs of GER were also in 18.75%. The results obtained indicate a good efficiency of cardiopexy with the round ligament of the liver, and a lower percentage of recurrence and complications in comparison with the Nissen– Rosetti technique (18.7%). The authors see the expediency of using the cardioterespexia technique in clinical practice both in the classical version and subject to its further improvement, which consists in increasing the mechanical properties of the round ligament of the liver and performing this operation by laparoscopic access.