Long-term results of treatment of gastroesophageal reflux disease in patients with hiatal hernia after video-laparoscopic surgery with various options for diaphragmochiatoplasty

Abstract

Introduction. The issue of choosing a material for videolaparoscopic correction of the esophageal hiatus remains controversial today. Objective. To study the long-term results of treatment of gastroesophageal reflux disease (GERD) in patients with hiatal hernia (HH) after video-laparoscopic surgical treatment with various options for diaphragmochiatoplasty. Materials and methods. An analysis of the long-term results of antireflux surgical treatment with various types of diaphragmochiatoplasty was carried out in 39 patients with GERD associated with hiatal hernia, operated on from 2004 to 2022 in the scope of video-laparoscopic dosed esophagofundoplication, posterior diaphragmocrurorrhaphy and diaphragmochiatoplasty. In patients of group 1 (24 patients), this operation was performed as an independent operation; in group 2 (15 patients), it was supplemented with peritonization of the mesh implant. To analyze long-term results, special (GIQLI, GERD-HRQL) and general (SF-36) questionnaires were used and the following special diagnostic methods were used: esophagofibrogastroduodenoscopy; manometry of the esophagogastric junction; intraesophageal daily pH-metry; polypositional fluoroscopy of the esophagus and stomach with contrast. Results. After surgery, GER according to the results of esophagofibrogastroduodenoscopy was detected in the first and second groups, respectively, in 8.33±5.76% and 13.33±9.08% of cases. According to the results of intraesophageal 24-hour pH-metry, the number of GER in the groups was 16.25±3.66 and 13.8±1.20, respectively, and the DeMeester index in the distal esophagus was 4.03±0.84 and 3.09±0,13. During manometry of the esophagogastric junction, the length of the cardia was on average 3.18±0.12 cm in patients of the first group and 3.09±0.13 in patients of the second group. The survey revealed significant differences between the groups in the pre- and postoperative period. We assume that in order to prevent possible serious complications, it is preferable to perform peritonization of the mesh implant during videolaparoscopic antireflux operations with diaphragmcruraphy and POD plastic surgery. Conclusion. There were no statistically significant differences between the group without peritonization and the group with peritonization of the implant in the postoperative period.