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The aim of the study was to assess the frequency of complications after laparoscopic Nissen fundoplication in patients with a hernia of the esophageal orifice of the diaphragm, to determine the features of diagnosis and treatment of gas-bloat syndrome. Materials and methods. According to the results of the meta-analysis, 10 % of patients with esophageal hiatal hernia developed inability to belch, 19 % – gas-bloat syndrome, 59 % – flatulence after laparoscopic Nissen fundoplication. The treatment results of two patients with gas-bloat syndrome at the SI “Shalimov’s National Institute of Surgery and Transplantation” of the National Academy of Medical Sciences of Ukraine for the period 2018–2020 are presented. Reconstructive fundoplication according to Toupet was performed in one patient, and one patient underwent endoscopic dilatation of the esophagogastric junction using a Boston Scientific 3.0 balloon. Conclusions. Pain reduction after a nasogastric tube placement and air venting from it is a tool to diagnose gas-bloat syndrome. Increasing aerogastria and stomach enlargement in 30–60 minutes after an additional meal make X-ray examination more informative and can be considered as new radiological symptoms. Toupet refundoplication is an effective surgical treatment for gas-bloat syndrome in patients after complete Nissen fundoplication.

Evolution of the gastric shunting operation

The aim. To evaluate the features and results of minimally invasive surgical treatment of patients with hiatal hernia (HH) and its main complications using modern endoscopic and laparoscopic technologies. Materials and methods. The treatment results of 244 patients with HH and its main complications are given. 28 (11.5 %) patients had a combination of HH with Barrett’s esophagus, and 34 (13.9 %) patients had a combination of HH with esophageal stricture. In 62 patients with complications of HH, two-stage treatment tactics was used. Complete laparoscopic fundoplication was performed in 185 (75.8 %) patients, posterior partial Toupet fundoplication – in 59 (24.2 %) patients. Laparoscopic posterior crurography was performed in 198 (81.1 %) patients. In 7 (2.9 %) posterior crurography was supplemented by anterior. Teflon gaskets were used in 25 (10.3 %) patients during posterior crurography. Synthetic mesh prostheses were implanted in 14 (5.7 %) patients. Results. In patients with esophageal stricture, the effect was observed after the second session of bougienage or hydro-dilation in 70.6 % of cases, after the third session - in the remaining cases. In Barrett's esophagus, a single session of argon plasma coagulation was radical in 100 % of patients with a lesion size less than 1 cm and in 85 % of patients with lesions of 1 cm to 2 cm in size. Recurrence of type III HH occurred more often than type I. The surgery required sufficient mediastinal dissection and mobilization for an adequate esophagus pull-through. In the surgical treatment of type IV HH, the use of composite diaphragmatic meshes was considered. The effectiveness of antireflux surgical intervention, as well as prevention of specific complications was depended on the technical features of the fundoplication cuff formation. Conclusions. In the treatment of Barrett’s esophagus or esophageal stricture in combination with HH, the two-stage tactics is optimal: stage I – ablation or dilatation, and stage II – laparoscopic antireflux surgery. Laparoscopic fundoplication is an effective and safe method for treatment of patients with HH.

Objective. To study metabolic changes and peculiarities of mineral balance depending on the common loop length while constructing of the simulated model of gastric shunting with one anastomosis during 60 days. Materials and methods. Experimental simulation of gastric minishunting with one anastomosis of various length of bilio-pancreatic loop was constructed on the rats. In 10 rats the anastomosis was formatted on level of half of total length of small intestine (Group I), and also in 10 - a third part of general length of small intestine (Group II). Control Group consisted of 5 rats. The indices of the extra body mass loss and metabolic changes were compared. Results. In the rats of Group I the index of the body mass loss have constituted 16.6% (41.7 gm), and of the Group II -20.6% (53.2 gm). Lowering of indices of mineral and prion metabolism, comparing preoperative values, was observed in both Groups. Dystrophic changes in osseous tissue of vertebral bodies of lumbar vertebral column were noted in animals of both Groups, more pronounced - in Group II. Conclusion. The protein and mineral metabolism disorders may be observed not only in large resection volume, but in exclusion of half and more segment of small bowel from general transit, using gastric shunting, what lacks significant advantages in the extra body mass loss, but leads to more profound metabolic disorders.

Objective. To improve the results of treatment in patients with insufficiency of duodenal sutures. Materials and metods. Retrospective and prospective investigation was accomplished on 17 patients, suffering insufficiency of sutures, injuries and fistulas of duodenum, who were admitted for treatment into Shalimov National Institute of Surgery and Transplantology during 2010-2020 yrs. In all the patients a complex examination, including a general clinical one, special laboratory and instrumental methods of investigation, was conducted. Results. Miniinvasive endoscopic method for the treatment of the duodenal sutures insufficiency was elaborated with a patent obtaining, which consists of endoscopic placement of a covered nitinol self-expanding stent into the defect zone. In presence of the complication, constituting a duodenal fistula, there was proposed to place a covered nitinol self-expanding stent into the defect zone together with vacuum-therapy from the side of the fistula external aperture. Due to application of the treatment method elaborated, it have become possible to reduce the morbidities quantity and to shorten the patients’ stationary stay by 36% - from (38.1 ± 4.16) to (25.4 ± 3.7) bed-days (p < 0.05). General mortality in the investigated group have constituted 9%, what was in two times lower, than the mortality index in a control group - 16%. Conclusion. The method, investigated by us, have constituted a combined approach with endoscopic placement of a self-expanding stent into the defect zone together with vacuum therapy from the external aperture of fistula, promoting improvement of the treatment results of the duodenal sutures insufficiency, accompanied by shortening of the patients’ stationary stay and reduction of morbidity and mortality.

Laparoscopic removal of concrement in Bouveret syndrome