Purpose

To analyze the results of recurrent and reconstructive operations with hernia hiatal.

Material and methods

This study presents the experience of performing operations on 1032 patients with hh. The number of surgeries performed at the department of surgery of the esophagus and stomach of the Republican clinical oncologic dispensary (Kazan) 1996—2015. All operations were performed by laparoscopy. We used the following types of fundoplication: Nissen–Rosetti — 852, Nissen — 174, Tupe — 6. The efficiency of the operations performed, we evaluated on the basis of complaints of patients, the data of endoscopic and radiologic examination. 50 (4.8%) of patients underwent re-operation, indications for re-operation were bleeding, persistent dysphagia, perforation of the stomach, recurrence of ger, secondary paraesophageal hh, postoperative hernia.

Results

50 patients underwent repeated surgery. Bleeding in the early postoperative period was observed in 3 (6,9%) patients. In two instances this complication has been eliminated by laparoscopy, and 1 patient performed laparotomy. Sources of bleeding were: trocaria punctures in 2 (66%) patients, short gastric vessels in 1 (34%) of patients. In 1 (2,5%) patient performed refundoplication on Nissen's caused by the tension of the gastro-splenic ligament (due to not previously cut the short gastric vessels). In 2 (4.8%) of patients diagnosed not noticed during surgery, perforation of the posterior wall of the stomach. In both patients laparotomy and suturing of the defect was performed on 2nd day. Secondary paraesophageal hh occurred in 2 (4.8%) of patients.

Conclusions

The main reasons for re-operations were: the destruction and migration of the fundoplication cuff — 32 (80%) cases, the phenomenon of "telescope" — 6 (15%) of the cases. The following results of reconstructive operations were identified: excellent, good and satisfactory results after the first reconstruction is 55%, poor — 45%; after the second — excellent, good and satisfactory results — 33%, unsatisfactory — 67%; after the third reconstruction — 100% unsatisfactory result. Laparoscopic fundoplication should be performed in specially equipped centers by experienced professionals, applying not only laparoscopic methods, but also having experience with open anti-reflux operations at HH. Patients who underwent surgery about HH, should be carefully adhere to dietary recommendations, weight control and comply with the restriction of exercise.