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2Хирургические болезни, травматология и ортопедия, урология
SURGICAL TREATMENT OF ESOPHAGEAL HERNIA BY NISSEN'S LAPAROSCOPIC FUNDOPLICATION
Aldashova A.B., Sailibayev A.E.
Astana Medical University, Astana, Republic of Kazakhstan Scientific supervisors: Tuganbekov T.U., Dr. Sci. (Med.), Professor; A.Zh. Omarbekov, Dr. Sci. (Med.), Docent; AbdikarimovA.M., Saipieva D.T.
Relevance. Hiatal hernia (HH) is one of the most common pathologies in surgery, with a prevalence of up to 26-50 % with an Increase in frequency in old age (Grintsov A.G., 2012). In the structure of diseases of the gastrointestinal tract, it ranks third after cholelithiasis, peptic ulcer of the stomach and duodenum (Evtikhov R.M., 2006). This pathology significantly reduces the quality of life and, in advanced cases, poses a serious threat to the lives of patients. According to our unpublished data, the probability of the formation of a diaphragmatic hernia increases in proportion to age - from 7 % (people younger than 40 years) to 67 % (people older than 50 years), with a predominance among women. The most frequent complaints are heartburn (60-82 %), dysphagia (25-50 %) or a combination of them (up to 15 %) and regurgitation (17-60 %). Nowadays laparoscopic fundoplication is the gold standard of HH treatment. According to statistics, the most frequent initial operations with HH are fundoplication by type Nissen (82 %), less often by type Toupet (7 %) - (Erin S.A., 2021).
The purpose of the work: To study the efficiency of surgical treatment of esophageal hernia by laparoscopic Nissen fundoplication.
Materials and methods of research. We analyzed the efficiency of surgical treatment of hiatal hernia in 99 patients who received treatment on the basis of JSC "National Scientific Medical Center" in Astana in 2021-2022 years. 53 women (53 %) and 46 men (47 %) were participated in the research. The average age was 55+12.9 (from 20 to 74 years). According to the type of hernia (Vasilenko classification), patients were distributed as: with sliding (axial) hernias 91 patients, giant hernias 2 patients, short esophagus 1 patient. Cardia insufficiency of the 1st degree was detected in 19 patients, second degree - in 28, third degree - in 11, fourth degree - in 2. According to the literature, a common concomitant pathology in patients with HH is cholelithiasis, which often requires simultaneous intervention. Laparoscopic Nissen fundoplication, posterior chiatoplasty, abdominal drainage was performed in 98 patients. Laparoscopic separation of the fundoplication cuff +viscerolysis and suturing of the true left hiatal hernia +laparo-scopic Nissen fundoplication, posterior chiatoplasty, drainage of the abdominal cavity were performed in two patients. Simultaneous surgical interventions for cholelithiasis were required in 5 patients in the volume of laparoscopic Nissen fundoplication, posterior chiatoplasty and drainage of the abdominal cavity in combination with laparoscopic cholecystectomy.
Research results. The average duration of the operation for all minimally invasive methods was 106 + 48.11minutes (from 60 to 330 minutes). The average volume of blood loss was 13 + 11.42 ml (from 5 ml to 50). The average stay in the intensive care unit in the postoperative period was 1 ± 1.5 days (min = 1; max = 4). The average stay of the patient in the surgical department after surgery was 5 ± 1.45 days (min-4, max-11). There were no cases of intraoperative and postoperative mortality.33 patients were available for follow-up for 1-2 years. Complete disappearance of clinical symptoms and good quality of life were noted in 20 patients. 4 patients had relapses, 3 patients had heartburn; 2 had belching, 2 had a feeling of heaviness after eating. According to various authors (statistics from Pubmed sources), structural complications after fundoplication occur in 25-30 % of patients.
Conclusions. Laparoscopic fundoplication is often the method of choice among antireflux operations in the treatment of hernias of the esophageal orifice of the diaphragm due to good patient tolerance, a small percentage of complications and high efficiency with rapid recovery of patients.
