Poor results of surgical treatment of hiatal hernias. Is there a solution to the problem?

Abstract

Hiatal hernias are the most common violation of visceral anatomy. Indications for surgical treatment of this pathology include refractory gastroesophageal reflux or anatomical changes, which carry a risk of developing life-threatening conditions. An unresolved problem in this area of surgery is the high recurrence rate of the disease, reaching 1040%. Subjective causes of unsatisfactory results are technical errors in performing interventions and violations of perioperative management. Compliance with the methodology of operations and the rules of patient management can minimize this group of factors. Large size of the hiatal opening, mechanical weakness of diaphragm crura and shortening of the esophagus are considered to be objective causes for the recurrent disease. An effective way to increase the reliability of the plastic esophageal opening of the diaphragm is the use of prosthetic materials. When the esophagus is shortened, it is possible to increase its length with the stomach (gastroplasty) or with the formation of a fundoplication wrap in the chest. Another option to increase the reliability of the operation may be fixing the stomach to the anterior abdominal wall (gastropexia) to prevent its redeployment to the chest. The use of this arsenal of techniques allows to reduce the frequency of unsatisfactory results after surgical treatment of hiatal hernias by up to 510%.