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https://doi.org/10.14300/mnnc.2019.14113

An integrated approach to the treatment of complicated forms of hiatal hernia taking into account the patient’s individual features

[Surgery]
Denis Mihajlovich Cherkasov; Mihail Cherkasov; Vladimir Tatyanchenko; Sabina Gadzhievna, Melikova; Yurij Mihajlovich Starcev; Viktor Borisovich Shamik;

We describe the treatment of 163 patients with complicated hiatal hernia. The research objective was to increase efficiency of treatment of patients with complicated forms of hiatal hernia using an integrated approach that takes into account specific features of the patient. Patients were divided according to body type. The integrated approach to the treatment of complicated forms of hiatal hernia included: conservative therapy, surgical treatment (Nissen or Nissen-Rossetti surgery), treatment control (endoscopy) for Barrett’s esophagus (esophageal mucosal metaplasia) and subsequent courses of argon-plasma
coagulation. Based on anatomical studies and CT data, we found that the area of the defect in the esophageal opening of the diaphragm is more pronounced in mature and elderly people with a brachymorphic body type. In these cases, as well as for large and giant hiatal hernias, plastics with own tissues may be insufficient and lead to relapse. To reduce recurrence, we developed a combined method of plastic surgery and back cruroraphy with use of a mesh.

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Keywords: hiatal hernia, gastroesophageal reflux disease, diaphragm, body type