Plasty of large and giant esophageal hernia of the diaphragm with the use of polypropylene mesh implants

Rosenfeld Igor Igorevich

The problem of increasing the efficiency of surgical treatment of diaphragmatic hernias is solved by improving the technique of surgery and choosing the type of implants. Both issues are scattered in medical literature and surgical practice, however, there is a significant gap in relation to large and gigantic hiatal hernias, which shows a high percentage of relapses. To solve this scientific problem, an integrated approach is proposed – a minimal traumatic technique of operations and a new type of implant. Purpose of the study. Evaluation of the effectiveness of modified alloplasty using polypropylene mesh implants in patients with a diagnosis of «hiatal hernia» of large (10–20 cm2) and gigantic (more than 20 cm2) sizes. Patients and methods. Only 89 patients with large and giant diaphragmatic hernias were operated from 2014 to 2017. An analysis was made of immediate and long-term results after surgery. The mathematical system for evaluating the results included the calculation of the statistical deviation from the average indicators and the overall result. Results. Repeated surgery was performed in 3 patients (10.3%): 1st patient for symptomatic anatomical relapse and functional relapse, 1st patient for symptomatic anatomical relapse, and 1st patient for esophageal stricture. The effectiveness of the proposed technique increases the result of the operation and forms a decrease in the risk of relapse to 3%. Conclusion. For large and giant hernias of the esophageal opening of the diaphragm, the modified plastic with a polypropylene mesh implant shows excellent results in the frequency of anatomical relapses. Prospects for reducing the percentage (3.4%) of relapses are seen in improving the surgical technique for performing surgery for hiatal hernia using polypropylene mesh implants.

Keywords:large hiatal hernia, giant hiatal hernia, alloplasty, polypropylene mesh implant, surgery technique.