Hiatal hernias: surgical tactics and recurrence (review article)

Introduction: Gastroesophageal reflux disease often develops in relation to the presence of hiatal hernias of various sizes. Various methods for surgical correction of this defect have been proposed over the years, including conventional and minimally invasive Nissen fundoplication, Nissen-Hill hybrid plasty, Kanshin valve gastroplication with subsequent fundoplication, Chernousov plasty, Collis-Nissen lengthening gastroplasty with fundoplication, Belsey-Mark IV procedure, and many others. Despite this, some authors report a high rate of symptomatic and asymptomatic recurrences, which are prevalent in association with type III/IV large hernial defects, obesity, or an unrecognized congenital or acquired short esophagus (brachyesophagus).Methods: A literature review was performed for the period from 2000 to 2025 using "Google Scholar" to search the databases Scopus, Web of Science, and PubMed. Key words used: "hiatal hernia", "fundoplication", "recurrence", "short esophagus", and their combinations. Original studies, systematic reviews, and meta-analyses that examined recurrence rates, preoperative and intraoperative strategies, and alternative surgical techniques for large and recurrent hiatal hernias were included.Results: When the ratio between the length of the esophagus measured during preoperative fibrogastroscopy and the height of the patient is less than 19.5; when the distance between the diaphragm and the cardia, measured by X-ray contrast examination, is more than 4 cm or the length of the abdominal part of the esophagus measured intraoperatively after mobilization is less than 1.5 cm, it is recommended to consider the possibilities of lengthening plasty.Conclusions: Preoperative and intraoperative assessment of the esophageal length is essential for determining the type of operative intervention and the need for esophageal lengthening. Timely diagnosis of brachyesophagus and its surgical correction significantly reduces the risk of recurrence and migration of the fundoplication cuff.