BACKGROUND
Today, it is a debatable question whether diaphragm chiatoplasty (DCP) should be performed during antireflux operations or not. Currently, there are few works that reflect the long-term results of treatment of patients with gastroesophageal reflux disease (GERD) in combination with hiatal hernia (HH) using DCP.
OBJECTIVE
To study the long-term results of GERD treatment in patients with HH after video-laparoscopic (VLS) esophagofundoplication combined with DCP.
MATERIAL AND METHODS
The results of surgical treatment of GERD in 47 patients with HH were studied. The patients were divided into two groups. The first group consisted of 31 patients who underwent VLS dosed esophagofundoplication, posterior diaphragmatic crurorrhaphy in combination with DCP. The second group included 16 patients who did not undergo DCP. Evaluation of long-term results of surgical treatment was carried out using a questionnaire and special research methods.
RESULTS
There were no statistically significant differences between the groups of patients with and without DCP after surgery, however, the indicators in the first group of patients are somewhat better: GER during esophagofibrogastroduodenoscopy was detected in 6.45±4.41% of patients in the first group and 12.5±8.54% of patients of the second group; GER and esophagitis were not detected by roentgenoscopy of the esophagus and stomach in patients of the first group, but were detected in 12.5±8.54% of patients of the second group; with intraesophageal daily pH-metry, the number of GER in patients of the first group averaged 13.77±2, in patients of the second group 15.53±2.77. The DeMeester index in the distal esophagus was 2.78±0.55 and 4.24±0.92, respectively. When manometry of the esophageal-gastric junction, the length of the cardia averaged 3.22±0.09 in patients of the first group and 3.13±0.14 cm in patients of the second group. With an increase in the distance between the crura of the diaphragm of more than 40 mm, the absence of a short esophagus and hypotrophic crura of the diaphragm, dosed esophagofundoplication with DCP is performed by VLS, which helps to reduce the frequency of esophagitis and GER.
CONCLUSION
A comprehensive assessment of the long-term results of GERD treatment in patients with HH after VLS surgery in combination with DCP was carried out using questionnaires and special diagnostic methods.
