THE DIAPHRAGM EVENTRATION UNDER THE GUISE OF RECURRENT PARAESOPHAGEAL HIATAL HERNIA

The clinical case presented in this article illustrates one of the serious iatrogenic complications of Nissen fundoplication: diaphragmatic eventration. A 65-year-old patient was diagnosed with recurrent paraesophageal hiatal hernia. Intraoperatively, it was treated as diaphragmatic eventration. Laparoscopic Nissen refundoplication, suturing of the diaphragm defect was performed. The patient was discharged in satisfactory condition on the 5th day.

[Features and results of minimally invasive treatment of recurrent achalasia]

OBJECTIVE

To evaluate the early and long-term postoperative outcomes in patients with recurrent achalasia, as well as the main features of surgical treatment.

MATERIAL AND METHODS

There were 7 patients (4 men and 3 women) with recurrent achalasia. Mean age of patients was 42.3±13.5 years, body mass index - 22.7±3.3 kg/m². Physiological status ASA grade 1-3 was observed in all patients. Concomitant diseases were diagnosed in 5 (71.4%) cases. Six (85.7%) patients underwent laparoscopic Heller cardiomyotomy with Dor fundoplication. Peroral endoscopic myotomy (POEM) was performed in 1 (14.3%) patient. Mean preoperative Eckardt score was 10.7±1.4 points, mean GERD-HRQL score - 42.7±6.4 points. According to preoperative radiography, 5 (71.4%) patients had achalasia stage III, 2 (28.6%) ones - stage IV.

RESULTS

All patients underwent laparoscopic Heller esophagocardiomyotomy with anterior Dor fundoplication and posterior partial fundoplication with posterior cruroraphy. Intraoperative complications (perforation of esophageal mucosa) occurred in 3 (42.9%) patients. Mean surgery time was 130±56 min, mean blood loss - 37 ml (35-205 ml), mean hospital-stay - 11.3±7.7 days. Postoperative complications Clavien-Dindo grade 3-4 were detected in 1 (14.3%) patient. One patient was diagnosed with bilateral pneumonia (SARS-Cov-2 infection) in 4 postoperative days. Median postoperative follow-up period was 22 months. Mean BMI in 6 months after surgery was 25.3±3.1 kg/m², mean Eckardt score - 2.1±0.7 points, mean GERD-HRQL score - 3.3±0.9 points.

CONCLUSION

Our data confirm the effectiveness and safety of the modified laparoscopic Heller procedure with Dor fundoplication as the main method for recurrent achalasia.

[Esophageal achalasia: possible pathogenic concepts from the perspective of modern notions]

Esophageal achalasia is an esophageal motility disease characterized by impaired relaxation of lower esophageal sphincter (LES) and severe clinical symptoms. The main etiological factors and other essential aspects of pathogenesis and progression of this disorder are actively studied. To date, the question of significance of etiological factors is experimental and requires further study. In this review, the authors analyzed and summarized the modern data on etiology and pathogenesis of this disease considering the new researches devoted to this issue.

ACHALASIA: DIAGNOSTIC FEATURES AND EFFECTIVE TREATMENT METHODS. REVIEW

Еsophageal achalasia is a neuromuscular disease of esophagus characterized by a distortion of the relaxation of the lower esophageal sphincter (LES) and manifested by marked clinical symptoms. To date, methods for diagnosing pathology and various surgical methods for its correction have been developed and actively used. In this review, the authors summarized all available data on principles of modern classification based on the identification of characteristic diagnostic criteria of the disease. The modern treatment methods are described in detail, the effectiveness of the presented methods is evaluated.

[Results of 300 pancreatic duct stenting in acute pancreatitis]

OBJECTIVE

To analyze the results of pancreatic duct stenting in moderate and severe forms of pancreatitis.

MATERIAL AND METHODS

Pancreatic duct stenting in 300 patients with acute pancreatitis was analyzed. Examination and treatment were carried out in accordance with national clinical guidelines for acute pancreatitis (2015).

RESULTS

Pancreatic duct stenting was performed in 300 patients with moderate and severe forms of pancreatitis (according to APACHE II) in the first 8-72 hours after the onset of the disease. Plastic stent sizes range from 4 to 7 cm in length and 5 to 7 Fr in diameter. Infection with pancreonecrosis occurred in 22 (7.3%) of 300 patients in the main group, and 20% of 150 patients in the control group. Mortality was 16 (5.3%) in the main group, and 24 (16%) - in the control group.

CONCLUSIONS

Pancreatic stenting reduced infection by 3, 2 times, and mortality by 4 times. The dosage of Octreotide was personalized depending on the severity of the disease according to APACHE II.

[Redo laparoscopic surgery for recurrent gastroesophageal reflux disease and hiatal hernia]

AIM

To assess mechanisms of recurrent gastroesophageal reflux disease and the ability to perform adequate surgical correction after previous surgery.

MATERIAL AND METHODS

The authors from various surgical centers have operated 2678 patients with gastroesophageal reflux disease and hiatal hernia for the period 1993-2018. 127 (4.74%) patients underwent redo surgery for recurrent disease, 46 of them were previously operated in other clinics.

RESULTS

Median follow-up after redo surgery was 63 months (12-139). Satisfactory functional result was achieved in 76.4% of patients.