Search

Resume. The aim of the study: improving the efficiency of surgical treatment for patients with hiatal hernia (HH) and HERD with reflux esophagitis through the development of a step-by-step method of surgical treatment aimed at saving and improving the anatomical and topographic solutions of the physiological cardia. Materials and methods. In 2017-2021, 78 patients with HH were examined and treated at the Department of Digestive Surgery of the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine, and in 16 (20, 8%) patients with HH in combination with GERD with reflux esophagitis. To confirm the diagnosis of HH and GERD, all patients undergo radiography, endoscopic examination, examination of pressure at the level of lower esophageal sphincter (LES). Results of the research. After the follow-up examination, found in 16 (20.8 %) patients with reflux esophagitis (in 3 (3.8 %) patients — esophageal ulcers). In 3 (3.8 %) patients with HH and GERD in combination with esophageal ulcer was treated in stages. The first stage of treatment was conservative therapy. After a course of therapy during endoscopic examination, esophageal stricture was detected. The second stage of treatment was balloon dilatation of the esophageal stricture. The third stage of treatment was antireflux surgery, which was performed in 78 (100 %) patients, in 11 (14.1 %) patients with HH, a new method of surgical correction of insufficiency of physiological cardia was proposed. Conclusions. The use of phased treatment of patients with HH and GERD with reflux esophagitis complicated by esophageal stricture and the proposed method of antireflux surgery ensures the elimination of pathological changes in HH, restores physiological cardia and preserves the anatomical relationship of the diaphragm and esophagus. In the postoperative period, the proposed method of surgical treatment reduces the likelihood of insufficiency of physiological cardia, dysphagia and recurrence of HH.

Summary. Purpose: to improve the results of surgical treatment of stenosis of the pyloroduodenal zone of ulcerative origin through the use of minimally invasive laparoendoscopic interventions. Material and methods. In the Department of Surgery of the Digestive Organs of the State Institution “Institute of Gastroenterology of the NAMS of Ukraine” for 2014-2019, 114 patients with stenosis of the pyloroduodenal zone of ulcerative origin were examined. Of these, 35 — with compensated stenosis, 57 — with subcompensated, 22 — with decompensated stenosis. The average age (45.3±5.2) years. The control group consisted of 20 healthy individuals. All patients underwent surgical treatment using minimally invasive and traditional surgical interventions. Results and discussion. During the study, known indications were clarified and new indications for performing endoscopic balloon pyloroduodenoplasty and combined laparoendoscopic intervention were clarified. Complications in the immediate postoperative period occurred in 1 patient (1.04%) in the form of perforation of the dilated zone. In patients after the traditional laparotomy surgery, the average postoperative period was (15 ± 2) days. Complications in the immediate postoperative period occurred in 2 patients (11.1 %) in the form of bleeding and leaks in the pyloroplasty zone, which required repeated surgical treatment. Тhere were no fatal cases. The remote observation period was 7-22 months. Endoscopic, radiological and clinical signs of recurrence of peptic ulcer and stenosis were not detected. Conclusions. The method of minimally invasive endoscopic and combined laparoendoscopic interventions in the treatment of stenosis of the pyloroduodenal zone of ulcerative genesis is characterized by a minimal number of complications, has good efficacy indicators and the absence of disease recurrence in the long-term period.

Summary. Aim. The aim of the work is to evaluate the effectiveness of the minimally invasive technique in the treatment of patients with achalasia of cardia. Materials and methods. In the Department of Surgery of the digestive organs of the Institute from February 2017 to December 2019, comprehensive treatment was examined and carried out using balloon pneumatic dilatation (PD) and Heller laparoscopic myotomy (LMH) in 21 patients with achalasia cardia. Including Men 8 (38.1 %), women 13 (61.9 %) at the age of 28 to 75 years ((51.47 ± 3.63) years). Results and discussion. Using radiation methods for examining the diameter of the esophagus, patients were divided into 4 stages: stage I with an esophagus diameter of up to 4 cm — 5 (23.8 %), stage II — 4–6 cm — 6 (28.6 %), III — 6–8 cm — 5 (23.8 %), IV — more than 8 cm with an S-shaped curved configuration — 5 (23.8 %) patients. The duration of the disease is from one month to 8 years, on average (3.05 ± 0.49) years. The symptomatic treatment efficacy after PD according to the Eckardt scale was 66.7-76.2 %, while after LMH it was 80.0%. The level of relaxation efficiency of the lower esophagus according to manometry was achieved in 81 % of cases. The effectiveness of a barium esophagogram in changing the height of a barium column after a bolus was successful in 76.2-85.7 % of cases. There were no complications when performing balloon PD and LMH. Conclusions. Relapses of achalasia of cardia after balloon PD were established in the period from 2 to 10 months in 33.3 % of cases: 4.7 % in stage I and 9.5 % of cases in stages II, III, IV. With AK relapses in 5 (23.8 %) cases, repeated use of dilatation was ineffective. Performed by LMH and fundoplication Door. The efficiency of balloon PD was 66.7 % after the initial course and 76.2 % after the second course, and the LMH efficiency after the failed PD was 80.0 %.