THE LONG-TERM RESULTS OF ENDOSURGICAL TREATMENT OF PARESISOPHAGEAL HERNIAS

Introduction. There is a perception that the use of a mesh for surgical treatment of paraesophageal hernias significantly reduces the number of recurrences. But considering the numerous complications associated with mesh reinforcement, there is a need of strong indication for it. It is not still clear what is the best shape of a mesh, the best material and the appropriate way of fixation. Thus, in last years with the accumulation of surgical experience there are a growing number of patients which are not satisfied with the results of operative approach. In this regard, it is important to study the long-term results of treatment and determine causes of failures.

Materials and methods. In the clinic of faculty surgery department based in Hospital № 21, Ufa, 22 laparoscopic operations for patients with parasophageal hernia were performed in 2012-2017 (main group). The comparison group consisted of 87 patients operated for sliding hiatal hernia without using a mesh. Long-term results were studied in terms of 6 to 60 months after the operation. 

Results. 9 (53%) of the patients in the main group and 54 (62%) of the control group had problems with swallowing in the early postoperative period. There was no difference in the incidence of early postoperative dysphagia between the groups (p = 0.1345). In the period from 6 months to 5 years after the operation, 13 (12%) patients complained of dysphagia of varying severity. Comparing the incidence of dysphagia in the main and control groups, a statistically significant difference was found in favor of the control group: 6 patients (27%) versus 6 patients (7%), p = 0.027. Comparing radiological recurrences of the hiatal hernia revealed a significant advantage in favor of the main group: no radiologic relapse versus 5 (6%) in the control group.

Conclusion. Laparoscopic surgical treatment of paraesophageal hernias types III and IV with the use of a mesh is an effective and safe method for up to 5 years after surgery, but the technical details of the operation still remain the subject of discussion. 

1. Dallemagne B., Perretta S. Twenty years of laparoscopic fundoplication for GERD. World J Surg. 2011;35(7):1428-35. DOI: 10.1007/s00268-011-1050-6.

2. Lebenthal A., Waterford S.D., Fisichella P.M Treatment and controversies in paraesophageal hernia repair. Front Surg. 2015;2:13. DOI: 10.3389/ fsurg.2015.00013.

3. Sasse K.C, Warner D.L., Ackerman E., Brandt J. Hiatal hernia repair with novel biological graft reinforcement. JSLS. 2016;20(2):e2016.00016. DOI: 10.4293/JSLS.2016.00016.

4. Грубник В.В., Малиновский А.В. Лапароскопическая пластика грыж пищеводного отверстия диафрагмы: новая классификация, основанная на отдаленных результатах. Эндоскопическая хирургия. 2014;20(1):9-15. [Grubnik V.V., Malinovskiĭ A.V. Laparoscopic plasty of hiatal hernias: new classification based on long-term results. Endoskopicheskaya khirurgiya=Endoscopic surgery. 2014;20(1):9-15 (in Russ.)].

5. Mĭller-Stich B.P., Senft J.D., Lasitschka F., Shevchenko M., Billeter A.T., Bruckner T., et al. Polypropylene, polyester or polytetrafluoroethylene-is there an ideal material for mesh augmentation at the esophageal hiatus? Results from an experimental study in a porcine model. Hernia. 2014;18(6):873-81. DOI: 10.1007/s10029-014-1305-x.

6. Stavros A., Koch O., Antoniou G.A., Pointner R., Granderath F.A. Mesh-reinforced hiatal hernia repair: a review on the effect on postoperative dysphagia and recurrence. Langenbecks Arch Surg. 2012;397(1):19-27. DOI: 10.1007/s00423-011-0829-0.

7. Тимербулатов М.В., Сендерович Е.И., Санников Е.Н. Опыт лапароскопического хирургического лечения параэзофагеальных грыж пищеводного отверстия диафрагмы. Пермский медицинский журнал. 2014;31(5):22-29. [Timerbulatov M.V., Senderovich E.I., Sannikov E.N. Experience of laparoscopic surgical treatment of paraesophageal hiatal hernias. Perm Medical Journal. 2014;31(5):22-29 (in Russ.)].

8. Makris K.I., Cassera M.A., Kastenmeier A.S., Dunst C.M., Swanstrĭm L.L. Postoperative dysphagia is not predictive of long-term failure after laparoscopic antireflux surgery. Surg Endosc. 2012;26(2):451-7. DOI: 10.1007/s00464-011-1898-4.

9. Mickeviĭius A., Endzinas Z ĭ., Kiudelis M., Jonaitis L., Kupĭinskas L., Pundzius J., et al. Influence of wrap length on the effectiveness of Nissen and Toupet fundoplications: 5-year results of prospective, randomized study. Surg Endosc. 2013;27(3):986-91. DOI: 10.1007/s00464-012-2550-7.

10. Niebisch S., Peters J.H. Update on fundoplication for the treatment of GERD. Curr Gastroenterol Rep. 2012;14(3):189-96. DOI: 10.1007/ s11894-012-0256-6.

11. Тимербулатов М.В., Сендерович У.И., Гришина Е.Е., Гарифуллин Б.М., Сахабутдинов А.М., Рахимов Р.Р. Давление нижнего пищеводного сфинктера как прогностический критерий результата антирефлюксной операции. Эндоскопическая хирургия. 2015;21(6):21-29. [Timerbulatov M.V., Senderovich E.I., Grishina E.E., Garifullin B.M., Sakhabutdinov A.M., Rakhimov R.R. Pressure of the lower esophageal sphincter as a prognostic test result of antireflux surgery. Endoskopicheskaya khirurgiya=Endoscopic surgery. 2015;21(6):21-29 (in Russ.)].

12. Panda A., Bhalla A.S., Sharma R., Arora A., Gupta A.K. «Straddling across boundaries»thoracoabdominal lesions: spectrum and pattern approach. Curr Probl Diagn Radiol. 2015;44(2):122-43. DOI: 10.1067/j.cpradiol.2014.11.005.

13. Pallati P.K., Shaligram A., Shostrom V.K., Oleynikov D., McBride C.L., Goede M.R. Improvement in gastroesophageal reflux disease symptoms after various bariatric procedures: review of the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis. 2014;10(3):502-7. DOI: 10.1016/j.soard.2013.07.018.