DIAGNOSIS AND SURGICAL CORRECTION OF ANATOMICAL AND TOPOGRAPHIC CHANGES IN CASE OF COMPLICATED HIATAL HERNIAS

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.