Короткий опис (реферат):
Background: Laparoscopic repair of giant hiatal hernias (HH) presents significant challenges, with traditional techniques often associated with high recurrence rates (30-50%) and complications. Objective: To evaluate the effectiveness of diaphragmatic relaxing incisions (DRI) during laparoscopic repair of large and giant HH. Methods: From 2018 to 2024, 172 patients underwent laparoscopic repair of HH. Preoperative assessments included barium swallow studies, CT scans, gastroscopy, and 24-hour pH monitoring. The cohort consisted of 68 men and 104 women, with a mean age of 54.8 years and an average BMI of 27.2. Hiatal surface area (HSA) was calculated for all patients, and suture tension during crural repair was measured in 52 cases. Relaxing incisions of the right crura (5-7 cm) were performed in 74 patients, while 20 patients underwent bilateral incisions (right crura and left diaphragmatic dome). Defects created by the incisions were repaired using self-fixating ProGrip mesh combined with Surgicell mesh. Results: Among the patients, 127 had large hernias (mean HSA 16.2 ± 3.4 cm²), and 45 had giant hernias (mean HSA 25.4 ± 5.2 cm²). Suture tension ranged from 4.6 to 15 N, with tension above 5 N identified as critical due to the risk of crural muscle splitting and subsequent recurrence. DRI of the right crura reduced tension by 55.3%, while bilateral DRI achieved a reduction of over 70%. In total, 94 patients underwent DRI: 74 patients had right crura incisions, and 20 had bilateral incisions. Following DRI, suture tension was reduced to below 5 N. Special synthetic pledgets were used for reinforcement in 78 patients with large hernias. Minor complications occurred in 15 patients (8.7%), and one patient died within 30 days postoperatively due to myocardial infarction. Follow-up (6 to 72 months) was completed for 157 patients, revealing a recurrence rate of 7.6% (12 patients). Four patients required reoperation, all of which had favorable outcomes. Conclusion: Diaphragmatic relaxing incisions (DRI) during laparoscopic repair of HH effectively reduce suture tension during cruroplasty, leading to lower recurrence rates. The use of ProGrip mesh and Surgicell mesh proved reliable for closing defects resulting from DRI.
