Complex minimally invasive treatment of patients with reflux esophagitis complicated by peptic stricture of the esophagus

Objective. Evaluation of the efficacy and safety of a comprehensive minimally invasive approach in the treatment of patients with reflux esophagitis (RE) complicated by peptic esophageal stricture, including staged dilation or bougienage followed by anti-reflux surgery. Material and methods. A retrospective analysis was conducted on the treatment outcomes of 62 patients (2011—2021) with peptic strictures due to RE and hiatal hernias (HH). At the first stage, bougienage (26 patients) or balloon dilation (36 patients) was performed under radiographic control. At the second stage, all patients underwent laparoscopic (n=42) or robot-assisted (n=20) fundoplication according to the A.F. Chernousov modification. The criteria for selecting the dilation method depended on the length of the stricture and the duration of dysphagia. Results. The average operation time was 106 minutes, with a blood loss of 40 ml. No access conversions or repeat surgeries were recorded. Complications (Clavien-Dindo I—II) were observed in 14.5% of patients, including transient dysphagia (17.7%) and gastrostasis (1.6%). The hospital stay duration was 6±2 days. In the long-term follow-up (median observation period — 58 months), stricture recurrence was detected in 6 patients (9.7%), managed with maintenance dilation. Regression of esophageal inflammation was noted in 83.8% of patients. Conclusion. The combined approach (dilation or bougienage+anti-reflux surgery) demonstrates high efficacy and safety by addressing the root cause of strictures — pathological reflux. Minimally invasive technologies reduce the risks of complications and restenosis, improving patients’ quality of life.