Лапароскопическая пластика гигантских грыж пищеводного отверстия диафрагмы принципиально новым сетчатым трансплантатом

Abstract

As rates of recurrence and prosthetic strictures following laparoscopic repair of giant hiatal hernias are large, creation of fundamentally new method of hiatoplasty is essential. The aim of the study was creation and clinical application of new prosthesis and method of its fixation. From 2010 to 2013, 43 laparoscopic repairs of giant types II and III hiatal hernias were performed. From them, 27 patients were followed within mean period of 15 months (range, 6-24). Mean hiatal surface area in this cohort was 33.5 cm2 (range, 24.6-75.4). Posterior tensionfree hiatal repair was performed with a new prosthesis — Rebound HRD-Hiatus hernia which was fixed to crura with 3-5 separated sutures. The prosthesis is heart-shaped lightweight polytetrafluorethylene mesh with peripheral nitinol frame. All procedures were successfully completed. Mean time of fixation of prosthesis was 25 min (range, 15-35). Pain scores were not larger than after standard mesh repair. Mid-term results studied by questionnaires, 3D barium study, endoscopic examinations, and 24h pH testing, showed no cases of recurrence and esophageal complications. New method is safe and provides good anatomical and functional mid-term results, and requires further development and comparison with other techniques