A new approach to the treatment of large and giant hiatal hernia

Objective. To retrospectively analyse the results of a new technique of laparoscopic surgery for large and giant hiatal hernias of the esophageal orifice of the diaphragm, which consists in the use of diaphragmatic incisions and mesh implants to reduce the incidence of recurrence and complications. Materials and methods. During the period from 2010 to 2023, laparoscopic interventions were performed in 62 patients, 43 (69.4%) women and 19 (30.6%) men, with large and giant hiatal hernias of the esophageal orifice of the diaphragm. The average age of the patients was 62.8 years. The diagnostic criteria used to select patients were the size of the hiatal opening and clinical symptoms. Fibroesophagogastroduodenoscopy, abdominal computed tomography, and contrast radiography were used to assess the size of the hernia and plan surgical intervention. During the operation, we performed loosening incisions of the diaphragm to reduce the tension during suturing of hiatus defects. Progrip self–locking meshes were also used to close the diaphragmatic defects, which allowed them to be securely fixed without tension and reduce the risk of recurrence. Results. Most patients had comorbidities that required a special approach during surgery. The average duration of the operations was 132 minutes, which indicates their technical complexity. The postoperative course in most patients was uncomplicated with a minimal recovery period. The average hospital stay was 5.2 days. Recurrence of hernia was detected in 2 (3.2%) of 62 patients, which indicates the effectiveness of the new technique. Conclusions. The use of a new concept of laparoscopic surgery for large and giant hernias of the esophageal orifice of the diaphragm, which involves the performance of laxative incisions of the diaphragm and the use of self–locking mesh, significantly reduces the incidence of recurrence and complications, which ensures high treatment efficiency and improves the quality of life of patients. The results of the study confirm the importance of an individual approach to the treatment of hiatal hernias and the possibility of optimising laparoscopic techniques to improve their effectiveness.