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The contemporary diagnosis and surgical treatment of hiatal hernias of esophagus


Author: Şipitco Natalia
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2007
Scientific adviser: Nicolae Gladun
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution:
Scientific council:

Status

The thesis was presented on the 14 November, 2007
Approved by NCAA on the 20 December, 2007

Abstract

Adobe PDF document – 1.32 Mb / in romanian

Thesis

CZU 616.329-007.43-07-089

Adobe PDF document 2.92 Mb / in romanian
132 pages

Keywords

hiatal hernia, sliding hiatal hernia, reflux esophagitis, surgery of esophagus, postoperative complications

Summary

The results of treatment of 122 patients with hiatal hernia (HH) associated with different grades of reflux-esophagitis (RE) during the period of 1995-2006 years are presented in this PhD thesis. The achievement of complex and multiaspect examination allowed effective and complete diagnostics of hiatal hernia.

It was demonstrated the importance of scintigraphy of esophagus in diagnosis of HH associated with RE and its role in selection of method of surgical correction.

The antireflux conservative treatment was used in 105 patients with RE of 0-2 grade according to classification of Savary-Miller (1976). Good results were achieved only in 15(14,3%) cases, satisfactory - in 30(29%) and unsatisfactory – in 60(57%) cases. The 98 patients from 122 with HH underwent surgical intervention, 70(71,43%) patients – by traditional way and 28(28,57%) – by laparoscopic way.

It was demonstrated the priority of surgical treatment in patients with HH. The number of good results after surgical interventions was obtained in 81,94% cases vs 14% in conservative treatment (p<0,001). The number of early and distant postoperative complications was considerably smaller after partial than after complete fundoplications type Nissen.

Experience of our clinic shows that miniinvasive interventions are operations of choice, because of excellent visibility during the operation, minimal postoperative pain, short-time hospitalization, fast restoration, cosmetic effect and at the same time the number of postoperative complications significantly diminishes from 31% to 17% (p<0,01).

It was proved that posterior cruroraphy in association with the method of partial fundoplication, realized by laparoscopic way, represents the gold standard in the surgical treatment of HH complicated with RE. Algorithms of diagnosis and treatment elaborated at our department substantial facilitate adequate decision-making in different situations caused by peculiarities of this pathology in every concrete case.