Type Of Diaphragmatic Hernia Research Articles

Utility of falciform ligament flap for hiatal hernia repair: a systematic review.

Surgical repair of hiatal hernia (HH) is plagued by high recurrence rates. Hiatoplasty failure has been identified as a major determinant of recurrent symptoms and HH, but there is no consensus on the optimal surgical approach to minimize this complication and hiatal mesh reinforcement remains controversial. The use of the falciform ligament as an autologous rotational flap to support crural repair has been proposed as a potential solution. This review aims to evaluate the safety and efficacy of the falciform ligament flap (FLF) as an adjunct in HH repair. Searches were conducted on Google, Google Scholar, PubMed, Scopus, Web of Science, and Cochrane through May 2024. The primary study outcome was HH recurrence rate. Secondary outcomes included 30-day mortality rate, postoperative morbidity, and length of hospital stay. Descriptive statistics were used to analyze the data. Twelve studies comprising 469 patients undergoing FLF augmentation during primary or revisional HH repair were included. The majority (80.7%) of patients had HH types III-IV. Crural suture hiatoplasty was performed in all cases, and adjunctive mesh reinforcement was reported in two studies. Postoperative morbidity was 4.6%, and there was no mortality. The overall HH recurrence rate was 5.8% (range 0-15.4%). Our study seems to suggest that FLF may reduce postoperative HH recurrence. Well designed and comparative studies with long-term follow-up are required to confirm these preliminary data.

The role of endoscopic ultrasound in assessment of physiological cardia insufficiency during diagnosis of hiatal hernia

Background. The aim of the study: to determine the role of endoscopic ultrasound (EUS) in assessing the failure of the physiological cardia in the diagnosis of hiatal hernias (HH). Materials and methods. At the Department of Digestive Surgery of the State Institution “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine” in 2023, we have performed surgical treatment of 33 patients with HH: axial HH were diagnosed in 21 (63.6 %) cases (I type), paraesophageal HH — in 12 (36.4 %) patients (II type) (ICD-10 code is K44). Control group included 20 practically healthy people. Results. All patients underwent an X-ray and endoscopic examination of the esophagus, stomach, duodenum, and EUS. All 33 (100.0 %) patients underwent an X-ray to confirm the diagnosis and an endoscopic examination to detect changes in the esophageal mucosa. EUS was performed in 31 (93.9 %) patients. The thickness of the esophageal wall was assessed using EUS, which made it possible to determine the state of the structures of the phy­siological cardia in HH: the displacement of part of the stomach above the diaphragm, location of the gastroesophageal junction relative to the legs of the diaphragm and relative to each other; the distance between the legs of the diaphragm (area of the HH) and their length; the cross-sectional area of the HH (hernial sac). The data obtained during EUS influenced the choice of the method for surgical correction of the physiological cardia with HH. Conclusions. Thus, with HH, EUS makes it possible to evaluate pathological changes of the main structures in the failure of the physiological cardia, to improve diagnosis for the types of HH, the location of the gastroesophageal junction, with determination of dimensions of the esophageal hiatus, the distance between the legs of the physiological cardia, localization and cross-section of the hernial sac, which influenced the choice of the surgery for physiological cardia in HH.

The initial outcomes of laparoscopic surgery for the hiatal hernia repair: a tertiary center study

Background: The surgical approach to hiatal hernia has changed with the advent of laparoscopic techniques. We sought to evaluate the short-term outcomes of laparoscopic hiatal hernia repair. Methods: We conducted a cross-sectional study with a retrospective approach of patients receiving laparoscopic hiatal hernia repair from January 2018 to June 2023 at People’s Hospital 115. Results: In 25 patients included in this study, the male-to-female ratio was 2:1, with a mean age of 46. The types of hiatal hernia included type I (n = 2), III (n = 16), and IV (n = 7). The most common symptoms were epigastric pain (44%), dysphagia (16%), heartburn (25%), vomiting (76%), chest pain (32%), and shortness of breath (20%). Nissen fundoplication was also performed in 19 cases (76%). The median operative time was 130 min, and the median hospital stay was 3 days. No case was converted to open surgery, and minor or major complications occurred in 3 patients (12%). Conclusion: Laparoscopic repair for hiatal hernia is feasible and safe. The short-term outcomes included early return daily activities, and most patients experienced good to excellent functional and symptomatic results and quality-of-life improvement.

Comparative assessment of clinical and endoscopic semiotics of hiatal hernias

A hiatal hernia (HH) of type III combines the anatomical characteristics of HH types I and II. The manifestations of type III HHs are diverse, and they can originate from either type I or type II, but so far, there is no certainty regarding the correlation between the clinical and endoscopic manifestations of HH type III and its origin.
 Objective — Based on the analysis of clinical and endoscopic manifestations of type III HH, justify the diversity of their characteristics depending on whether they originate from type I or type II HH.
 Materials and methods. The study included 126 patients with HH, including 87 type III hernias and 39 type I hernias, who underwent elective laparoscopic hernioplasty. The study consisted of several steps. In the first step, an assessment of the results of endoscopic examination in patients with type III HH was conducted to determine the diversity of the obtained data and the feasibility of dividing patients into subgroups using a two‑stage cluster analysis. In the second step, the subgroups obtained through cluster analysis were compared between themselves and with the patients with type I HH to determine the similarities or differences in endoscopic findings and clinical symptoms.
 Results. Cluster analysis identified two clusters of indicators with a strong degree of association and differentiation. The main factor in the differentiation into clusters was the relationship between the gastroesophageal junction (GEJ) and the upper border of the HS (hernia sac) in an inversion. Based on this criterion, type III HH can be divided into two subgroups: type IIIA, where the GEJ is located proximally or at the same level as the highest point of the HS, and type IIIB, where the GEJ is located distally to the highest point of the HS. The occurrence of most endoscopic symptoms of HH in subgroup IIIA, in contrast to IIIB, did not significantly differ from type I HH, except for the shorter length of the esophagus and the greater axial length of the hernia. Additionally, patients with the IIIA HH subtype were almost indistinguishable from those with type I HH in terms of clinical characteristics, except for a higher average age and the occurrence of dyspnea. In subtype IIIB, compared to type I, symptoms related to gastroesophageal reflux were significantly less frequent, while symptoms indicative of impaired food evacuation were more frequent. The observed similarity between the endoscopic and clinical manifestations of type I and subtype IIIA HH suggests a common origin for these conditions. On the other hand, subtype IIIB, which differs in endoscopic and clinical indicators from type I and subtype IIIA HH, is evidently the result of the progression of type II HH.
 Conclusions. Patients with type III HH exhibit significant diversity in clinical and endoscopic manifestations, which is attributed to the different origins of the HH (from type I or type II). An endoscopic feature indicating the hernia’s origin is the position of the GEJ relative to the highest point of the HS: below it corresponds to type II HH (62.1%), while at or above it corresponds to type I HH (37.9%).

Effects of Spinal Deformities on Hiatal Hernia Occurrence and Recurrence

BackgroundSpinal deformities such as kyphosis, lordosis, and scoliosis have demonstrated a possible association between these deformities. Our hypothesis is that the presence of spinal deformities will increase the risk of hiatal hernia recurrence after repair. MethodsThe following data was retrospectively gleaned for patients undergoing hiatal hernia repair (1997–2022): age, sex, date of hiatal hernia repair, presence and type of spinal deformity, Cobb angle, type of hiatal hernia and size, type of hiatal hernia repair, recurrence and size, time to recurrence, reoperation, type of reoperation, and time to reoperation. ResultsSpinal deformities were present in 15.8% of 546 patients undergoing hiatal hernia repair, with a distribution of 21.8% kyphosis, 2.3% lordosis, 58.6% scoliosis, and 17.2% multiple. There was no difference in sex or age between groups. Spinal deformity patients were more likely to have types III and IV hiatal hernias (52.3% vs. 38.9%, p = 0.02) and larger hernias (median 5 [3-8] vs. 4 [2-6], p = 0.01). There was no difference in access, fundoplication use, or mesh use between groups. However, these patients had a higher recurrence rate (47.7% vs 30.0%, p = 0.001) and a shorter time to recurrence (months) (10.3 [5.6-25.1] vs 19.2 [9.8-51.0], p = 0.02). Cobb angle did not affect recurrence. ConclusionsSpinal deformity patients were more likely to have more complex and larger hiatal hernias. They were at higher risk of hiatal hernia recurrence after repair with shorter times to recurrence. This is a group that requires special attention with additional preoperative counseling and possibly use of surgical adjuncts in repair.

Robotic-assisted versus laparoscopic paraesophageal hernia repair: a systematic review and meta-analysis.

The robotic approach offers improved visualization and maneuverability for surgeons. This systematic review aims to compare the outcomes of robotic-assisted and conventional laparoscopic approaches for paraesophageal hernia repair, specifically examining postoperative complications, operative time, hospital stay, and recurrence. A systematic review including thorough research through PubMed, Scopus, and Cochrane, was performed and only comparative studies were included. Studies concerning other types of hiatal hernias or children were excluded. A meta-analysis was conducted to compare overall postoperative complications, hospital stay, and operation time. Ten comparative studies, with 186,259 participants in total, were included in the meta-analysis, but unfortunately, not all of them reported all the outcomes under question. It appeared that there is no statistically significant difference between the conventional laparoscopic and the robotic-assisted approach, regarding the overall postoperative complication rate (odds ratio [OR], 0.56, 95% confidence interval [CI], 0.28-1.11), the mean operation time (t = 1.41; 95% CI, -0.15-0.52; p = 0.22), and the hospital length of stay (t = -1.54; degree of freedom = 8; 95% CI, -0.53-0.11; p = 0.16). Only two studies reported evidence concerning the recurrence rates. Overall, the robotic-assisted method did not demonstrate superiority over conventional laparoscopic paraesophageal hiatal hernia repair in terms of postoperative complications, operation time, or hospital stay. However, some studies focused on cost and patient characteristics of each group. Further comparative and randomized control studies with longer follow-up periods are needed for more accurate conclusions on short- and long-term outcomes.

Videolaparoscopic surgical treatment of strangulated paraesophageal hiatal hernia (clinical observation)

Relevance. Paraesophageal hiatal hernias are much less common than other types of diaphragmatic hernias. The risk of strangulation in this pathology is about 21 %. It is often very difficult to establish the correct diagnosis in time, because patients are admitted with an atypical clinic of acute cardiological or pulmonary pathology. Usually, the correct diagnosis is established only on the 4th day. Due to late diagnosis, necrosis and perforation of the strangulated organ occur, which causes high mortality; sometimes the correct diagnosis is established only at autopsy.Clinical observation. The patient was admitted to the surgical department on an emergency basis with complaints of intense pain in the lower chest and epigastric region, vomiting of eaten food. From the anamnesis it is known that about a year ago, periodic nausea and vomiting of food eaten began to bother. The last 12 hours before admission to the hospital, pain in the chest and epigastrium intensified, all eaten food came out with vomiting. X-ray diagnosed strangulated paraesophageal hernia of the esophageal opening of the diaphragm. During esophagogastroduodenoscopy it was impossible to pass into the distal parts of the stomach; hyperemia and petechial hemorrhages were detected in the zone of strangulation. Video-laparoscopic reduction of the hernial contents, resection of the hernial sac and anterior diaphragm crurorrhaphy were urgently performed. The early postoperative period was uneventful. The presented clinical observation indicates the promise of using video-endoscopic technologies for diagnosis and treatment of strangulated diaphragmatic hernias. The key to success is the timely establishment of the correct diagnosis. We consider it impractical to perform an antireflux intervention simultaneously in conditions of an acute inflammatory process.

Laparoscopic Surgery with Concomitant Hernia Repair and Cholecystectomy: An Alternative Approach to Everyday Practice.

Concomitant surgeries have been performed previously in several centers with experience in laparoscopic surgeries. These surgeries are performed in one patient under one operation with anesthesia. We performed a retrospective unicenter study from October 2021 to December 2021 analyzing patients who underwent laparoscopic hiatal hernia repair with cholecystectomy. We extracted data from 20 patients who underwent hiatal hernia repair together with cholecystectomy. Grouping of data by hiatal hernia type showed 6 type IV hernias (complex hernia), 13 type III hernias (mixed type) and 1 type I hernia (sliding hernia). Out of the 20 cases analyzed, 19 were patients suffering from chronic cholecystitis and 1 patient presented with acute cholecystitis. The average operating time was 179 min. Minimum blood loss was achieved. Cruroraphy was performed in all cases, mesh reinforcement was added in five cases, and fundoplication was performed in all cases, with 3 Toupet, 2 Dor and 15 floppy Nissen fundoplication procedures performed. Fundopexy was routinely performed in cases of Toupet fundoplication. A total of 1 bipolar and 19 retrograde cholecystectomies were performed. All patients had favorable postoperative hospitalization. Patient follow-up took place at 1 month, 3 months and 6 months, with no sign of recurrence of hiatal hernia (anatomical or symptomatic) and no symptoms of postcholecystectomy syndrome. In two patients, we had to perform colostomy. Concomitant laparoscopic hiatal hernia repair and cholecystectomy is safe and feasible.

The results of treatment of newborns with right-sided and left-sided intrathoracic localization of the liver with diaphragmatic hernia

BACKGROUND: The right-sided congenital diaphragmatic hernia is the rare pathology. Results of diagnostics, prognosis and treatment usally published as a collection of cases.
 AIM: Comparition of treatment results of congenital diaphragmatic hernia with the liver as its content in dependancy of the side.
 MATERIALS AND METHODS: We present a retrospective analysis of 50 newborn patients with congenital diaphragmatic hernia. Patiens were divided in two groups, first with right-sided (19 patients), and second with left-sided hernia (31 patients). Groups were compared by gender and weigth. Comparition criteria was the results of prenatal and postnatal diagnostics, intraoperative data, postoperative period, complications and outcomes.
 RESULTS: We found predominance of prenatal diagnosis in the second group (48% vs 84%, p = 0,001). The lung-to-head circumference ratio were the same in both groups (0,52 in first, 0,46 in second, p = 0,058). Chance to use thoracoscopic approach in the second group was higer in 5,7 times (48% vs 84%). Postoperative period was easier in the group of right-sided congenital diaphragmatic hernia: artificial ventilation lasted on average 8 days (min 3; max 28) versus 11 (min 4; max 50) days in the first group (p = 0,036).
 Hospital stay was significantly lower in the second group 18 days (min 12; max 28), versus 50 days in the first group (min 13; max 64), p = 0,011. Recovery chance in patients with right-sided hernia was higher (45% vs 79%, confidence interval 0,0590,814).
 CONCLUSIONS: Every type of diaphragmatic hernia, including right-sided location, need to be the subgect of research of high compitantive center. Prognostic criteria for right-sided congenital diaphragmatic hernia require furter advanced study, wich is possible only in case of concentration of patients in the same center.

Laparoscopic Management of Giant Paraesophageal Hernia: Case Report and Review

There are 4 types of hiatal hernia, being type IV the rarest of all. The management today remains controversial about the ideal approach (abdominal, thoracic, mixed approach, laparoscopic or open surgery), the use or not of mesh, what type of fundoplication (anterior, posterior, total or parcial). We will present a giant paraesophageal hernia with gastric herniation and transverse colon resolved by laparoscopy, in an emergency surgery.

Preoperatif Aneminin Hiatal Herni Cerrahisi ve Postoperatif Komplikasyonlara Etkisi

Aim: Anemia is associated with increased mortality and morbidity in all patients undergoing surgery. This study aimed to reveal to what extent anemia caused postoperative complications before hiatal hernia surgery. Material and Methods: One hundred and ninety-two patients operated for hiatal hernia in our clinic between 2015 and 2019 were analyzed retrospectively. Patients were compared according to demographics, preoperative laboratory values, preoperative Charlson comorbidity index score, hiatal hernia type, postoperative intensive care requirement, presence of postoperative complications, Clavien-Dindo score, blood transfusion need, and length of hospital stay. Results: Of the patients, 109 were female and 83 were male. The mean age was 50.1±9.1 years. Fifty-four (28.2%) of the patients were in the anemic group, and 138 (71.8%) were in the non-anemic group. There was no statistically significant difference between the groups in terms of gender distribution (p=0.663). When the groups were compared in terms of age distribution, it was found that the anemic group was older than the non-anemic group and the difference was statistically significant (p<0.001). There was a significant difference between the groups in terms of the postoperative complications rate and it was more common in the anemic group (p<0.001). There was a significant difference between the groups in terms of the need for intensive care and blood transfusion in the postoperative period (p=0.020, p<0.001, respectively). Conclusion: Preoperative anemia increases postoperative complications in hiatal hernia surgery. Therefore, the presence of anemia should be investigated before hiatal hernia surgery and patients with anemia should be followed up closely postoperatively.

Diagnosis and surgical correction of insufficiency of physiological cardia in hiatal hernia

Background. The purpose of the study was to improve the diagnosis and improving the results of surgical treatment of patients with hiatal hernia (HH) and GERD by applying the developed method of surgical correction of insufficiency of physiological cardia aimed at preserving and restoring the anatomical and topographic relationships of the esophagocardial organs. Materials and methods. In the Department of Digestive Surgery of the State Institution “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine” for the period 2017–2021 conducted a study in 78 patients with HH, including: axial HH (typeI) was 60 (77.0%) patients; paraesophageal (type II)— 9 (11.5%) patients; mixed (type III)— 9 (11.5%) (code for ICD-10— K44). To establish and confirm the diagnosis, patients underwent radiological and endoscopic examination of the esophagus, stomach, duodenum, manometry. Results. In the analysis of complaints of examined patients it can be noted that the most common clinical manifestations in patients with HH and GERD were heartburn in 73 (93.7%), belching in 68 (87.2%) and epigastric pain in 64 (82.0%). The erosions of the lower third of the esophagus was found in 13 (16.7%) patients, while according to the Los Angeles classification in 6 (7.7%) patients had esophagitis grade A, 7 (8.9%) patients— grade B. According to the results of the manometry study, the highest pressure was observed in patients with axial HH and was (13.54±3.32) mm Hg, and the lowest— in patients with GERD and was (9.81±3.18) mm Hg. After a comprehensive examination, 3 (3.8%) patients after confirmation of the diagnosis of HH in combination with Barrett’s esophagus underwent two-stage treatment: the first stage performed argonoplasmic ablation of altered esophageal mucosa, the second stage— antireflux surgery. All of 78 (100%) patients underwent antireflux surgery. Laparoscopic fundoplications were performed: the Nissen fundoplication was performed in 53 (67.9%) patients, Toupet fundoplication in 7 (8.9%) patients and Dor fundoplication in 5 (6.6%) patients, cruroraphy was performed in 100.0%. The 11 (14.1%) patients underwent surgery according to a new method that provides reliable restoration of physiological cardia and preservation of the anatomical relationship of the diaphragm and esophageal-gastric junction and includes cruroraphy and fundoplication. Conclusions. The method of surgical treatment of insufficiency of physiological cardia in HH, proposed by us, aimed at the correction of physiological cardia is less traumatic than known, provides a reliable restoration of the anatomical relationship of the esophagogastric region.

Endoscopic signs of gastroesophageal reflux disease with different hiatal hernias types

A hiatal hernia occurs in 83–94 % of patients with gastroesophageal reflux disease (GERD). Difficulties in diagnosing endoscopic signs of gastroesophageal reflux with combination of the most common hiatal hernia types remain relevant. Untimely and inaccurate endoscopic interpretation of these pathological changes significantly reduces the effectiveness of treatment. The aim of the research was to study the endoscopic signs of gastroesophageal reflux disease with the most common hiatal hernia type I and type III. Materials and methods. The examination results of 153 patients with GERD and the most common hiatal hernia type I and type III at the stage of preparation for antireflux surgical treatment were analyzed. The age was 54.5 ± 11.3, there were 48 (31.4 %) men, 105 (68.6 %) women. In Group I – 85 patients with GERD and type I hiatal hernia, in Group II – 68 patients with GERD and type III hiatal hernia. A complete preoperative examination necessarily included endoscopy with chromoendoscopy (mainly NBI or FICE), biopsy from suspicious foci of the gastric mucosa and the lower third of the esophagus followed by histological analysis. Statistical processing and mathematical analysis of the obtained results were performed using the Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J). For comparative analysis the arithmetic mean and standard deviation were calculated and presented as M ± s. Differences between groups were assessed using the sub-module “Difference tests” in the module “Basic statistics and tables”. Differences at P < 0.05 were considered statistically significant. Results. In both groups, non-erosive forms of gastroesophageal reflux disease prevailed: 57 (67.1 %) and 39 (57.4 %) patients respectively. Both in Groups I and II, among the erosive forms there were mainly LA A stages of esophagitis – 20 (23.5 %) and 17 (25.0 %). СLE signs of the esophageal mucosa prevailed in Group I – 16 (18.8 %) patients, in Group II – 5 (7.4 %) patients. The proximal edges of the gastric folds, which are visualized in all patients, were considered the reference point for the true esophageal-gastric junction. Complicated course of GERD was noted in both groups of patients. Conclusions. Endoscopic signs of GERD with hiatal hernia type I or type III have characteristic features, the severity of which manifestation does not depend on the type. A reliable indicator of the true esophageal-gastric junction location is the proximal edge of the gastric folds. Complicated course of GERD occurs in both groups: Barrett’s esophagus and Schatzki’s ring predominate in the Group I, strictures and ulcers of the esophagus – in the Group II.

Opioid-Free Anesthesia and Same-Day Surgery Laparoscopic Hiatal Hernia Repair.

Laparoscopic hiatal hernia repair is commonly performed with a 1 to 2 night hospitalization. Our aim was to compare the feasibility and short-term outcomes of same-day surgery (SDS) laparoscopic hiatal hernia repair with an opioid-based anesthesia protocol (OBAP) vs an opioid-free anesthesia protocol (OFAP). Outcomes and pharmacy costs of repairs with OBAP were compared with OFAP. Values were expressed as median (interquartile range) and costs as means. There were 244 primary laparoscopic repairs. OBAP was used in 191 of 244 (78.3%) vs OFAP in 53 of 244 (21.7%). The length of stay was 1 day (0 to 2) vs 0 days (0 to 1), p = 0.006. There was no difference between the percentage of patients requiring analgesics and dosage between the 2 groups. SDS was planned in 157 and performed in 74 of 122 (60.7%) vs 33 of 35 (94.3%), p < 0.001. The age was 56 years (45 to 63) vs 60 years (56 to 68), p = 0.025. There were more type I hiatal hernia in SDS-OBAP and more type III and IV in SDS-OFAP, p = 0.031. American Society of Anesthesiologists Physical Status was II (II-III) vs III (II-III), p = 0.045. SDS was not performed in 50 of 157 (31.8%), 48 of 122 (39.3%) vs 2 of 35 (5.7%), p < 0.001. Out of 157 planned SDS, nausea/retching were causes of transition in 19 of 122 (15.6%) vs 0 of 35 (0%), p = 0.020. Multivariable logistic regression showed the odds of SDS were 8.21 times (95% CI 3.10 to 21.71; p < 0.001) greater in OFAP compared with OBAP, adjusting for sex, age, body mass index, American Society of Anesthesiologists Physical Status, type of hiatal hernia, type of procedure, and duration of the operation. Patients with opioid medication after SDS discharge were 74 of 74 (100%) vs 22 of 33 (66.7%), p < 0.001. Opioid-free anesthesia increases the feasibility of SDS hiatal hernia repair with less perioperative nausea and comparable pain control and pharmacy cost.

Hiatal hernia types and their radiological diagnostics in patients with gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal pathology. In more than 80–90 % of patients, GERD is caused by the presence of hiatal hernia, leading to the failure of the lower esophageal sphincter. Therefore, experts increasingly agree that GERD can be effectively treated surgically in this case with a detailed diagnosis and assessment of hiatal hernia types. One of the most common methods for diagnosing hiatal hernia is radiological. But the results of the data interpretation obtained during preparation for surgical treatment are contradictory. This situation requires work continuation in this direction. The aim of the study was to improve radiological diagnosis and conduct a detailed analysis of the hiatal hernia types in GERD patients. Materials and methods. The examination results of 120 patients with GERD were analyzed. The mean age was 55.1 ± 10.7, there were 34 (28.3 %) men, 73 (71.7 %) women. In all patients, polypositional radiological examination (“Opera T 90cex”, “General Medical Merate S.p.A.”, Italy) of the esophagus, stomach with a water-soluble contrast agent (barium), photographic fixation, video recording and video analysis was performed. An internationally accepted classification was used to assess the hiatal hernia types. All patients were candidates for surgical treatment by laparoscopic cruroraphy and Nissen or Toupet fundoplication. The results of the preoperative examination were specified intraoperatively. Statistical processing of the obtained results was performed using the Statistica for Windows 13.0 software package (StatSoft Inc., USA). Results. In all patients, hiatal hernias were diagnosed. Type I hernias – in 94 (78.3 %) patients, type II hernias – in 3 (2.5 %), type III hernias – in 15 (12.5 %), type IV was detected in 8 (6.7 %) patients. The features of radiological diagnostic of hiatal hernia types were analyzed in detail, and steps to improve it were proposed. The issues of large and giant hernias diagnosis and definition were addressed. All results were illustrated with our own photographic material. A quantitative and qualitative assessment of the obtained results was carried out. Conclusions. The leading role of various hiatal hernia types in the development of GERD has been suggested. Type I hiatal hernia has been presented as the most common among such patients. Detailed X-ray diagnostics with the use of photographic fixation, video recording and video analysis has been shown to be the important and effective method for determining the anatomical features of hiatal hernia types as the main factors of the esophagogastric junction disruption and, consequently, the development of GERD.

Indications for Repair of Asymptomatic or Minimally Symptomatic Paraespophageal Hernias: Gastroenterologist’s Perspective on Management

Paraesophageal hernias (PEHs) are a relatively uncommon type of hiatal hernia, thought to comprise only 5% of all hiatal hernias, affecting mainly older adults. Historically, surgical repairs for PEHs were reserved for symptomatic hernias refractory to medical management (i.e., reflux, dysphagia, regurgitation, anemia, dyspnea, or abdominal pain) or complications related to (i.e., bleeding, obstruction, or volvulus). Elective repair in asymptomatic or minimally symptomatic patients remain controversial. Here, we overview the indications and up to date evidence for repair for the asymptomatic and minimally symptomatic PEHs. Our approach is reflective of opinion, based on evidence and our experience, and focused on the following questions regarding PEHs: (1) What is the natural history for untreated PEHs and (2) What is the reported value for surgical repair of PEHs versus observation.

Plastic for diaphragmal hernia

Aim. The article discusses the results of a study using a patented method of two-layer laparoscopic repair of large and giant hiatal hernias using a biocarbon implant in comparison with other surgical techniques.Materials and methods. 716 patients were divided into 3 study groups based on the area of the size of the esophageal hernia defect: group I (314 patients) – with small (less than 5 cm2) and medium (5–10 cm2) hiatal hernias, that is, up to 10 cm2, which hernioplasty was performed only by the method of posterior cruraphy; group II (323 patients) – with large hernias 10–20 cm2: subgroup 1 (92 patients) underwent posterior cruraphy, subgroup 2 (231 patients) – alloplasty. Depending on the alloplasty technique, subgroup 2, in turn, was divided: subgroup A (89 people) – hernioplasty with a polypropylene implant and subgroup B (142 people) – hernioplasty with a medical biocarbon construction. Study group III (79 patients) – patients with giant diaphragmatic hernias of more than 20 cm2 using alloplasty: subgroup A (29 people) – hernioplasty with a polypropylene implant and subgroup B (50 patients) – alloplasty with a medical biocarbon construction.Results. When comparing group I with subgroup 1 of group II, the following results were obtained. Statistically significant differences were found in the degrees and types of diaphragmatic hernias. The average age of patients and statistical differences for it were insignificant. When comparing subgroup 1 with subgroup 2 of group II, statistically insignificant differences were found in the degrees and types of hiatal hernias. The difference in the average age of patients was also statistically insignificant. The difference in the average age of patients was also statistically insignificant. When comparing subgroup A with subgroup B of group II, statistically insignificant differences were found among themselves in the degrees and types of hiatal hernias. When comparing subgroup 2 of group II with group III, the difference turned out to be statistically significant in the distribution of patients by types and degrees of diaphragmatic hernias. When comparing subgroup A with subgroup B of group III by degrees and types of hiatal hernias, statistically insignificant differences were revealed.Conclusion. Posterior cruraphia in small and medium diaphragmatic hernias had significant statistical differences in types and degrees compared to that in large hernias, as well as in the average area of the hernial defect. Posterior cruraphia with hernioplasty in large hiatal hernias did not differ statistically significantly according to any of the criteria. Plastic surgery with a polypropylene implant with alloplasty of a biocarbon implant for large hernias did not differ significantly according to any of the criteria. Hernioplasty for large hiatal hernias, when compared with giant hernias, differed significantly only in the degree and type, as well as in the area of the hernial defect. «Onlay» plastic surgery with a polypropylene implant with alloplasty of biocarbon structures for giant hernias did not differ significantly according to any of the criteria, except for gender distribution, which did not have significant fundamental significance, which made it possible to make a more correct comparison of the results of surgical interventions in these research subgroups.

A case of wrong diagnosis of paraesophageal hernia in a patient with a white line hernia

Among all the anatomical variants for the hiatal hernia development, a true paraesophageal hernia is the most rare. The clinical manifestations of this type of hiatal hernia are caused by the infringement of the diaphragmatic crus or by transient obstruction of the esophagus with the development of organic dysphagia. The leading method of instrumental diagnostics of this pathology is contrast x-ray study of the esophagus and stomach with functional tests. The article describes a clinical case of an incorrect interpretation of the symptoms of the disease and the results of EGD in favor of paraesophageal hernia in association with GERD in a patient with a large white line hernia under conditions of migration into the hernial sac of the stomach and duodenum.

Возможности диагностики и лапароскопических методов лечения грыж пищеводного отверстия диафрагмы

Цель исследования: оценка диагностических возможностей и результатов хирургического лечения больных с грыжами пищеводного отверстия диафрагмы (ГПОД). Материалы и методы. В отделении хирургии органов пищеварения ГУ «Институт гастроэнтерологии НАМН Украины» за период с 2013 по 2018 год лапароскопические вмешательства по поводу грыж пищеводного отверстия диафрагмы и гастроэзофагеальной рефлюксной болезни были выполнены у 119 пациентов. Результаты. Среди оперированных пациентов у 101 (84,9 %) был установлен диагноз «аксиальная ГПОД (тип І)», у 14 (11,8 %) — «параэзофагеальная ГПОД (тип II)», «смешанная ГПОД с укороченным пищеводом (тип III)» — у 4 (3,4 %). Крурорафия выполнена у 100 % пациентов: задняя — у 67 (56,3 %) пациентов, передняя и задняя — у 36 (30,3 %), у 16 (13,4 %) пациентов — сочетанная и аллопластика. Выполнены лапароскопические фундопликации: фундопликация по Нис­сену — у 96 (80,7 %) пациентов, фундопликация по Тупе — у 12 (10,1 %), фундопликация по Дору — у 11 (9,2 %) пациентов. Фундодиафрагмопексия выполнена у 87 (73,1 %). Летальных исходов после оперативных вмешательств не было. Выводы. Результаты исследования свидетельствуют о высокой эффективности лапароскопических методов в хирургическом лечении пациентов с ГПОД, хорошо переносятся пациентами и характеризуются небольшим процентом интраоперационных и отсутствием послеоперационных осложнений, что позволяет признать их операциями выбора в лечении данной патологии.

Досвід хірургічного лікування гриж стравохідного отвору діафрагми лапароскопічним доступом

Актуальність. Діагностика та лікування хворих із грижею стравохідного отвору діафрагми (ГСОД) є однією з найбільш актуальних проблем сучасної медицини. Мета роботи — надати досвід хірургічного лікування гриж стравохідного отвору діафрагми лапароскопічним доступом. Матеріали та методи. У відділенні хірургії органів травлення ДУ «Інститут гастроентерології НАМН України» за період з 2013 по 2017 р. лапароскопічні втручання з приводу ГСОД і ГЕРБ були виконані у 67 пацієнтів. Результати. Серед оперованих пацієнтів у 64 (95,6 %) була аксіальна ГСОД (тип I), у 2 (2,9 %) — параезофагеальна ГСОД (тип II), у 1 (1,5%) — змішана ГСОД з укороченим стравоходом. Крурорафія виконана у 100 % пацієнтів: задня — у 60 (89,6 %), передня — у 2 (2,9 %), поєднана — у 5 (7,5 %) і алопластика — у 6 (8,9 %) пацієнтів. Виконано лапароскопічні фундоплікації: за Ніссеном — у 46 (68,7 %), за Дор — у 7 (10,4 %), за Тупе — в 14 (20,9 %) пацієнтів. Фундодіафрагмопексія виконана у 61 (91,0 %) пацієнта. Симультанні оперативні втручання виконані у 5 (7,4 %) пацієнтів, конверсії — в 1 (1,4 %). Летальних випадків після оперативних втручань не було. Висновки. Результати дослідження свідчать про високу ефективність лапароскопічного доступу в хірургічному лікуванні пацієнтів із ГСОД.