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.

Background. The purpose was to develop indications for surgical treatment of patients with hiatal hernias and evaluate its results. Materials and methods. At the Department of Surgery of Digestive Organs of SI “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”, 45 patients with hiatal hernias were examined in 2017–2019. Long-term treatment results were studied within 6 months to 2 years in 19 (42.2 %) individuals. Results. In our studies, among 45 operated patients, 27 (60.0 %) had a diagnosis of axial hiatal hernia (type I), 9 (20.0 %) — paraesophageal hiatal hernia (type II), 8 (17.8 %) — combined hiatal hernia (type III), 1 (2.2 %) patient had hiatal hernia with a shortening of the esophagus (type IV). Grade I of hiatal hernia was noted in 25 (55.6 %) people, grade II occurred in 12 (26.7 %), and grade III, when body and even the antral part of the stomach prolapse into the posterior mediastinum, — in 8 (17.8 %) patients. Cruroplasty was performed in 100 % of cases: posterior — in 24 (53.3 %) individuals, anterior and posterior (сombined) — in 13 (28.9 %), alloplasty — in 8 (17.8 %). Laparoscopic fundoplication was carried out in all patients: Nissen fundoplication — in 36 (80.0 %), Toupet fundoplication — in 6 (13.3 %), Dor fundoplication — in 3 (6.7 %). There were no fatal cases. The average duration of surgery was (135 ± 24) min, the average time of transplant fixation — (24 ± 12) min. Conclusions. Therefore, laparoscopic antireflux operations are highly effective in the treatment of hiatal hernias, well tolerated and characterized by a low percentage of complications (6 (13.3 %) cases), rapid recovery of patients in the postoperative period, allowing them to be recognized as surgery of choice in the treatment of this pathology. The choice of surgical procedure for hiatal hernia is determined by the features of anatomical interrelations and the purpose of restoring the esophageal-gastric junction and diaphragm.

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.

A decomposition method of total algebraic complements with “screening” and the topology transformation method have been proposed for symbolic simulation of circuit functions. They are based on decomposition of the simulated circuit and the use of index operations in calculating the model matrix determinant and algebraic complements of its elements.