The laparoscopic antirefluix surgery for hiatal hernias: early results

Abstract

Introduction: Hiatal hernias have been the focus of surgeons over many years. The update of this subject is due to the increasing number in patients with these diseases as a result of diagnostic possibilities, with the advantages of laparoscopic approach. Hiatal hernia in 66% cases is associated with gastro-esophageal reflux. Surgical treatment of hiatal hernia consists of removing the hernia sac through cruroraphy and antireflux procedure. Purpose: Review of the contemporary laparoscopic management of hiatal hernias. Materials and methods: 35 laparoscopic antireflux surgeries were performed during 2011. Axial hiatal hernias were recorded in 30(85,5%) cases, while hiatal mixed hernias- in 5(14,5%) combined cases. All patients were examined endoscopically, X-ray, and pH-metric studies. All the patients had a preoperative period which included the drug therapy for gastroesofageal reflux. Results: The average age of patients was 48 years. There were 21 60%) women, and 14(40%) men. In the department of general surgery were operated all the 35 patients through laparoscopy. In 31(88,6%) cases underwent previous cruroraphy with fundoplication Nissen-Rossetti, in 4(11,4%) cases - by pr. Dor. The posterior cruroraphy has been used as a standard method in all cases. The average hospitalization period was 7 days. In all 35 cases the esophago-gastrography control was administrated with barium before the discharge of patients. Intraoperative complication wasn’t registered. In the postoperative period 7 (20%) patients showed clinical signs of dysphagia, this regressed after administration of the drug treatment. There were no conversions. The follow-up results were not evaluated. Conclusions: 1. Patients with hiatal hernias may benefit from the advantages of laparoscopic antireflux surgery. 2. In most of patients the postoperative dysphagia had a transitory character.