Experience in treatment of diaphragm hernias

Abstract

Hernias of the diaphragm are a common pathology that negatively affects the quality of life of patients and in some cases requires high-quality surgical correction. This pathology has a progressive course, which leads to an increase in the severity of clinical manifestations with the age of the patient. The article presents the experience of surgical treatment of hernias of the diaphragm on the basis of general surgery clinics of the military medical academy. The aim of the study is to determine the effectiveness of surgical treatment of hernias of the diaphragm in different categories of patients. The total number of treated patients was 216. All patients were operated on. Thirty-four patients underwent a sympultal laparoscopic cholecystectomy. The operation used laparoscopic access. The closest excellent and good results of clinical treatment occurred in 92% of cases, satisfactory and unsatisfactory results accounted for 5.4 and 2.7%, respectively. According to the results of the instrumental survey, 40.6 and 54%, respectively, achieved excellent and good results; Satisfactory and unsatisfactory — 2.7 and 2.7%. The introduction of laparoscopic techniques in surgery has reduced the number of early and late post-operative complications in the treatment of hernias of the diaphragm. The recommendations of the American Association of Endoscopic Surgeons for the operational treatment of gastroesophageal reflux disease shows the positive effect of laparoscopic fundoplications in 85–93% of patients whose medicinal therapy has proved ineffective. In general, the results of the immediate and long-term outcomes of the surgical treatment of hernias of the diaphragm at the General Surgery Clinic of Military Medical Academy showed similar results (8 figs, bibliography: 16 refs).

Keywords

hernias of the diaphragm / treatment

References

[1] Clifton M. S., Wulkan M. L. Congenital Diaphragmatic Hernia and Diaphragmatic Eventration. Clin. Perinatol. 2017; 44 (4): 773–9.

[2] Tyson A. F., Sola R. Jr., Arnold M. R., Cosper G. H., Schulman A. M. Thoracoscopic Versus Open Congenital Diaphragmatic Hernia Repair: Single Tertiary Center Review. J. Laparoendosc. Adv. Surg. Tech. A. 2017; 27 (11): 1209–16.

[3] Zyabreva I. A., Dzhulay T. E. Esophageal hernia of the diaphragm: controversial, unresolved and promising aspects of the problem (literature review). Upper Volga Medical Journal. 2015; 4: 24–8. Russian (Зябрева И. А., Джулай Т. Е. Грыжи пищеводного отверстия диафрагмы: спорные, нерешенные и перспективные аспекты проблемы (обзор литературы). Верхневолжский медицинский журнал. 2015; 4: 24–8).

[4] Tumarenko A. V., Skvortsov V. V. Hernia of the diaphragm in the practice of a therapist. Krymskiy terapevticheskiy zhurnal. 2015; 4: 80–4. Russian (Тумаренко А. В., Скворцов В. В. Грыжа пищеводного отверстия диафрагмы в практике терапевта. Крымский терапевтический журнал. 2015; 4: 80–4).

[5] Fetishcheva L. E., Zakharov I. S., Ushakova G. A., Moses V. G., Demyanova T. N., Vasyutinskaya Yu. V., Petrich L. N. Interstitial pregnancy — diagnostic difficulties. Mat’ i ditya v Kuzbasse. 2017; 2(69): 55–58. Russian (Фетищева Л. Е., Захаров И. С., Ушакова Г. А., Мозес В. Г., Демьянова Т. Н., Васютинская Ю. В., Петрич Л. Н. Интерстициальная беременность — трудности диагностики. Мать и дитя в Кузбассе. 2017; 2 (69): 55–8).

[6] Inoue M., Uchida K., Otake K., Nagano Y., Mori K., Hashimoto K., Matsushita K., Koike Y., Uemura A., Kusunoki M. Thoracoscopic repair of congenital diaphragmatic hernia with countermeasures against reported complications for safe outcomes comparable to laparotomy. Surg. Endosc. 2016; 30 (3): 1014–9.

[7] Herman A., Maiti A., Cherian S. V., Estrada-Y-Martin R. M. Heimlich Maneuver-Induced Diaphragmatic Rupture and Hiatal Hernia. Am. J. Med. Sci. 2018; 355 (4): e13.

[8] Sigal E. I., Burmistrov M. V. Benign diseases of the esophagus. Tikhookeanskiy meditsinskiy zhurnal. 2009; 2: 40–7. Russian (Сигал Е. И., Бурмистров М. В. Доброкачественные заболевания пищевода. Тихоокеанский медицинский журнал. 2009; 2: 40–7).

[9] Grintsov A. G., Sovpel’ O. V., Shapovalov Yu. A., Mate V. V. Functional results of laparoscopic surgery for hiatal hernia. Vestnik neotlozhnoy i vosstanovitel΄noy meditsiny. 2012; 2: 242–5. Russian (Гринцов А. Г., Совпель О. В., Шаповалов Ю. А., Мате В. В. Функциональные результаты лапароскопических операций при грыжах пищеводного отверстия диафрагмы. Вестник неотложной и восстановительной медицины. 2012; 13 (2): 242–5).

[10] Shwaartz C., Duggan E., Lee D. S., Divino C. M., Chin E. H. Diaphragmatic eventration presenting as a recurrent diaphragmatic hernia. Ann. R. Coll Surg. Engl. 2017; 99 (7): e196–9.

[11] Akhmatov A. M., Tarbaev I. S., Vasilevsky D. I. Surgical treatment of hiatal hernia of type II–IV diaphragm. Vestnik khirurgii. 2019; 1: 90–2. Russian (Ахматов А. М., Тарбаев И. С., Василевский Д. И. Хирургическое лечение грыж пищеводного отверстия диафрагмы II–IV типов. Вестник хирургии. 2019; 178 (1): 90–2).

[12] Pham D. V., Protyniak B., Binenbaum S. J., Squillaro A., Borao F. J. Simultaneous laparoscopic paraesophageal hernia repair and sleeve gastrectomy in the morbidly obese. Surg. Obes. Relat. Dis. 2014; 10 (2): 257–61.

[13] Dallemagne B., Quero G., Lapergola A., Guerriero L., Fiorillo C., Perretta S. Treatment of giant paraesophageal hernia: pro laparoscopic approach. Hernia. 2018; 22 (6): 909–19.

[14] Siegal S. R., Dolan J. P., Hunter J. G. Modern diagnosis and treatment of hiatal hernias. Langenbecks. Arch. Surg. 2017; 402 (8): 1145–51.

[15] Chan E. G., Sarkaria I. S., Luketich J. D., Levy R. Laparoscopic Approach to Paraesophageal Hernia Repair. Thorac. Surg. Clin. 2019; 29 (4): 395–403.

[16] Guidelines for Surgical Treatment of Gastroesophageal Reflux Disease (GERD). Society of American Gastrointestinal and Endoscopic Surgeons. 2020.

RIGHTS & PERMISSIONS

Zubarev P.N., Khokhlov A.V., Onnitsev I.E., Trofimov V.M., Belevich V.L., Muzharovskiy A.L.