mossjМосковский хирургический журналMoscow Surgical Journal2072-3180ООО «ПРОФИЛЬ – 2С»10.17238/2072-3180-2025-3-220-227mossj-1043Research ArticleЛИТЕРАТУРНЫЕ ОБЗОРЫLITERARY REVIEWSИндивидуализированный подход к выбору повторного антирефлюксного вмешательстваPersonalizes approach to selecting revision antireflux surgerhttps://orcid.org/0000-0001-8621-906XЧжанТ.ZhangT.

Цай Юйцин – аспирант 

119992, ул. Трубецкая, д. 8с2, Москва 

Zhang Tong – Postgraduate student 

119992, Trubetskaya str., 8/2, Moscow 

caiyuqing618@gmail.comhttps://orcid.org/0000-0002-8763-6743ЦайЮ.CaiY.

Чжан Тонг – аспирант 

119992, ул. Трубецкая, д. 8с2, Москва 

Cai Yuqing – Postgraduate student  

119992, Trubetskaya str., 8/2, Moscow 

zhangtong3124@gmail.comhttps://orcid.org/0000-0002-6359-0998ГаллямовЭ. А.GallyamovE. A.

Галлямов Эдуард Абдулхаевич – д.м.н., профессор, заведующий кафедрой

119992, ул. Трубецкая, д. 8с2, Москва 

Gallyamov Eduard Abdulkhaevich – Doctor of Medical Sciences, Professor, Head of the Department

119992, Trubetskaya str., 8/2, Moscow 

gallyamov_e_a@staff.sechenov.ruhttps://orcid.org/0000-0002-2187-9371СадыковА. Р.SadykovA. R.

Садыков Айрат Рашидович – студент лечебного факультета научно–образовательного института клинической медицины им. Н.А.Семашко

127006, ул. Долгоруковская, д.4, Москва 

Sadykov Airat Rashidovich – Student

127006, Dolgorukovskaya str., 4, Moscow 

sar_03@mail.ruКафедра общей хирургии ФГАОУ ВО Первый МГМУ им. И.М. Сеченова Минздрава России (Сеченовский Университет)РоссияDepartment of General Surgery of the First Moscow State Medical University. THEM. SechenovRussian FederationКафедра общей хирургии ФГБОУ ВО “Российский университет медицины” Минздрава РоссииРоссияDepartment of Surgery of the Russian University of Medicine of the Ministry of Health of the Russian FederationRussian Federation20252209202503220227Copyright © Чжан Т., Цай Ю., Галлямов Э.А., Садыков А.Р., 20252025Чжан Т., Цай Ю., Галлямов Э.А., Садыков А.Р.Zhang T., Cai Y., Gallyamov E.A., Sadykov A.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.mossj.ru/jour/article/view/1043

Введение. Рецидивы хиатальных грыж и гастроэзофагеальной рефлюксной болезни (ГЭРБ) после первичного хирургического лечения остаются сложной проблемой в абдоминальной хирургии. Частота рецидивов достигает 15–60 % а основные проявления включают рецидив рефлюкса, дисфагию и gas–bloat синдром. Причины рецидивов многофакторны: миграция фундопликационной манжеты, рубцовые стриктуры, слабость диафрагмальных структур и технические погрешности.Цель исследования. Анализ существующих методик рефундопликации и разработка индивидуализированных подходов к повторной антирефлюксной операции, основанных на тщательной предоперационной диагностике, анализе причин неудачи первичной операции и выборе оптимального метода коррекции (тип фундопликации, необходимость протезирования, мобилизация пищевода).Материалы и методы исследования. Статьи, опубликованные в научных базах PubMed, Web of Science, Scopus, eLIBRARY.Результаты исследования. Проведение комплексной мультимодальной диагностики позволяет причины рецидива ГПОД и ГЭРБ. При больших дефектах оправдано использовать U–образную синтетическую сетку. При укорочении пищевода менее 1 см – гастропластика по Коллису: более 1–2 см – применение методики по Черноусову. Полная фундопликация применима при тяжелом рефлюксе и нормомоторике, парциальная – при выраженной дисфагии и гипомоторике, передняя – при рубцовом фиброзе или в качестве дополнения кардиомиотомии при ахалазии.Заключение. Ревизионная хирургия требует строго индивидуализированной тактики. Её успех определяется точной диагностикой, корректным выбором методов (комбинация крурорафии, сетчатой пластики и фундопликации), устранением анатомических дефектов, опытом хирурга и соблюдением реабилитационных норм, минимизируя рецидивы в сложных случаях.

Introduction. Recurrences of hiatal hernias and gastroesophageal reflux disease (GERD) following primary surgical treatment remain a challenging problem in abdominal surgery. Failure rates reach 15–60 %, with key manifestations including recurrent reflux, dysphagia, and gas–bloat syndrome. The causes of recurrence are multifactorial: fundoplication wrap migration, cicatricial strictures, diaphragmatic weakness, and technical errors from the initial procedure.The purpose of the study. To analyze existing fundoplication techniques and develop personalized approaches to reoperative antireflux surgery. This strategy is based on comprehensive preoperative diagnostics, analysis of primary surgery failure causes, and selection of optimal corrective methods (fundoplication type, mesh reinforcement necessity, esophageal mobilization).Materials and methods of research. Review of articles published in scientific databases such as PubMed, Web of Science, Scopus, and eLIBRARY.Results of research. Performing comprehensive multimodal diagnostics enables identification of the causes of recurrent hiatal hernia and GERD. For large defects, the use of a U–shaped synthetic mesh is justified. For esophageal shortening less than 1 cm, Collis gastroplasty is indicated; for shortening exceeding 1–2 cm, Chernousov's technique is applied. A complete fundoplication is applicable in cases of severe reflux with normal motility, a partial fundoplication is used for significant dysphagia and hypomotility, and an anterior fundoplication is indicated in the presence of cicatricial fibrosis or as an adjunct to cardiomyotomy for achalasia.Conclusion. Revisional surgery requires strictly individualized management. Success depends on: precise diagnostics, appropriate technique selection (combined cruroplasty, mesh repair, fundoplication), anatomical defect correction, surgical expertise, and adherence to rehabilitation protocols – minimizing recurrences in complex cases.

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The authors declare that there are no conflicts of interest present.