Principles of surgical treatment of recurrent hiatal hernias (review of literature)

Abstract

Recurrent hiatal hernia is the re-displacement of the abdominal organs into the chest after surgical treatment. Indications for repeated surgical interventions for this pathology are resistant to medical correction gastroesophageal reflux or anatomical disorders, bearing the risk of developing life-threatening conditions. The key task of revision interventions is to identify and address the causes of the failure of the primary operation. The main factors of the recurrence of hernias of this localization are the large size of the hiatal opening, the mechanical weakness of the legs of the diaphragm and the shortening of the esophagus. To increase the reliability of the esophageal aperture plasty in the surgical treatment of recurrent hiatal hernias, prosthetic materials are widely used. When the esophagus is shortened, it is possible to increase its length by creating a gastric stalk (gastroplasty) or fixing the stomach to the anterior abdominal wall (gastropexy). The disadvantage of both methods is the occurring functional impairment. An alternative approach is the formation of a fundoplication wrap in the chest with the closure of the esophageal opening only with its own tissues. To eliminate or prevent the development of gastroesophageal reflux, antireflux reconstruction is an essential component of operations for recurrent hiatal hernias. The option of fundoplication is selected in accordance with the contractility of the esophagus. With normokinesia, circular fundoplication was preferred, with impaired motor skills – free reconstructions.