Modern aspects of diagnosis and surgical treatment of hiatal hernias: Literature Review

Abstract

Laparoscopic correction is the main method of treating hiatal hernias. However, despite more than thirty years of experience, many issues remain controversial and require compilation and standardization. The authors have analyzed the latest scientific studies and recommendations on the treatment of hiatal hernias with a high level of evidence, which is presented in the form of a review with a comparison of their own experience in surgical treatment of 171 patients operated on for hiatal hernias. The risk of transition of an asymptomatic hiatal hernia to a clinically significant one is 1% per year, while observation, rather than active surgical tactics, is indicated. Only symptomatic hernias are subject to surgical treatment. Surgical intervention should include the following mandatory steps: dissection of the esophagealdiaphragmatic ligament with excision of the hernial sac while protecting the branches of the vagus nerve; dissection of both crura of diaphragm, transhiatal mobilization of the esophagus in the mediastinum to achieve the length of its intraabdominal segment of 2–3 cm; if a short esophagus is suspected, a mandatory step is to perform Collis gastroplasty; mobilization of the gastric fundus by dividing gastrointestinal ligament and short gastric arteries; creation of a fundoplication cuff on a calibration probe of at least 30–36 Fr. The choice of the fundoplication and cruroraphia methods did not significantly affect the long-term results of treatment. Laparoscopic interventions are the most effective way to treat patients with hiatal hernias, due to their safety, low trauma, low complication rate and the possibility of rapid rehabilitation of patients. The technique of surgical intervention needs a clarified standardization.