PREVENTION OF POSTOPERATIVE DYSPHAGIA DURING LAPAROSCOPIC FUNDOPLICATION IN PATIENTS WITH HEAT HERNIA

Purpose of the study. Improving methods for preventing the development of dysphagia after laparoscopic fundoplication in patients with hiatal hernia.Material and methods. A comprehensive analysis of diagnostic data and results of surgical treatment of 140 patients with a diagnosed hiatal hernia (HH) was carried out. According to the study design, the patient cohort was stratified into two groups. The control group consisted of 67 patients who underwent traditional open surgery. The main group included 73 patients who underwent videolaparoscopic correction of the НН using developed methods for the prevention of postoperative dysphagia.Results. In the control group (n = 67), surgical correction of the НН was carried out through a classic laparotomy approach using standard surgical techniques. In the main group (n = 73), in 68 (93.2%) cases, various modifications of videolaparoscopic fundoplication with posterior crurorrhaphy were used. Only 5 (6.8%) patients, according to strict indications, underwent laparotomy operations with Nissen fundoplication in a clinical modification, also with posterior crurorrhaphy. In order to prevent dysphagia of varying severity, the mesh prosthesis was covered with a strand of omentum. Also, during videolaparoscopic Nissen fundoplication, the formation of a soft cuff was used using a Blackmore probe to dose the degree of tension of the fundoplication. Analysis of postoperative complications demonstrated significant differences between the study groups regarding the incidence of dysphagia. In the main group, dysphagia of varying intensity was recorded in only 4 patients, which amounted to 5.5% of the total number of observations. In the control group, this complication occurred much more often – in 13 patients (19.4%).Conclusion. Thus, the obtained statistical data convincingly demonstrate the clinical effectiveness of the developed set of preventive measures in preventing the development of mechanical dysphagia in the postoperative period.