ОПЫТ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ОСЛОЖНЕННЫХ ФОРМ ГРЫЖ ПИЩЕВОДНOГО ОТВЕРСТИЯ ДИАФРАГМЫ С УЧЕТОМ КОНСТИТУЦИОНАЛЬНЫХ ОСОБЕННОСТЕЙ ПАЦИЕНТОВ

Hiatal Hernias are common diseases in surgical and gastroenterological practice and are detected in almost 30% of the adult population of Russian Federation. Purpose of the study: improving the treatment results for patients with complicated forms of hiatal hernia by developing an individual integrated approach taking into account the body type, anatomical and agerelated features. Materials and methods. In this work, age and constitutional features of the biomechanical properties of fascial structures, as well as blood supply to the diaphragm, are studied on 40 preparations from human corpses. The clinical part of the work includes the experience of treating 163 patients with complicated forms of hiatal hernias. Results. Based on the data of anatomical studies, plastic surgery of the esophageal opening of the diaphragm was performed, using own tissues (n = 124) and using mesh implants (n = 39). Late postoperative complications were studied up to 5 years in 117 of 124 patients (94.4%) with using their own tissues and in all 39 patients with using mesh implants. After surgery with using own tissues, 11 (9.4%) late complications were revealed: fundoplication cuff migration noted in 3 patients, telescope phenomenon - 2 cases, cuff hyperfunction - in 1 and gastroesophageal reflux - in 5 patients. In the group of patients with mesh implants, only one patient (2.6%) showed gastroesophageal reflux, the effect was achieved by using conservative treatment methods. There were no relapses of the disease both with using own tissues and with the use of mesh implants. Conclusion. In the second mature period and in old age, especially in individuals of a brachymorphic body type with large hernias of the esophageal opening of the diaphragm, mesh implants should be used to strengthen the diaphragmatic legs. The developed original method of surgery using a mesh implant allows to reduce the risk of damage to adjacent organs and structures.

hiatal hernia, gastroesophageal reflux disease, body type