Fundoplication and gastroplication in reconstructive surgery for cardiofundal, subtotal, and total hiatal hernias

Introduction. Surgical intervention is the only radical treatment for reflux esophagitis associated with hiatal hernia. The technique of creating a complete symmetric fundoplication or gastroplication cuff, developed by Professor A.F. Chernousov, has demonstrated its efficacy and is currently the method of choice in the surgical treatment of this pathology.

Purpose of the study. To present the results of surgical treatment of patients with cardiofundal, subtotal, and total gastric hiatal hernias who underwent creation of a complete symmetric fundoplication or gastroplication cuff via conventional and laparoscopic approaches.

Materials and Methods. Surgical treatment was performed in 48 patients with reflux esophagitis associated with cardiofundal, subtotal, or total hiatal hernia. The first group included 35 patients who underwent laparoscopic surgery (fundoplication – 8, gastroplication – 27, posterior cruroplasty – 26). The second group included 13 patients who underwent laparotomy (fundoplication – 6, gastroplication – 7, posterior cruroplasty – 11). Radiological control was performed on postoperative days 3 and 7.

Results. Grade I–II complications according to the Clavien–Dindo classification were observed in 4 (8,3 %) patients and were managed conservatively. According to postoperative radiological examination with oral contrast in the early postoperative period, surgical treatment was effective in all patients regardless of the surgical approach.

Conclusion. A complete symmetric antireflux cuff created by fundoplication or gastroplication demonstrates high clinical efficacy in the treatment of reflux esophagitis. The key success factors are its symmetry and complete esophageal wrap, whereas intra- or supradiaphragmatic localization and the type of surgical approach do not have a statistically significant impact on the long-term antireflux outcome. Excision of the hernia sac from the posterior mediastinum is also mandatory. Correction of the diaphragmatic esophageal hiatus diameter using posterior cruroplasty without mesh implants is effective in the treatment of subtotal and total hiatal hernias.

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