EXPERIENCE OF LAPAROSCOPIC SURGICAL TREATMENT OF PARAESOPHAGEAL HIATAL HERNIAS
Aim. To present the experience of laparoscopic surgical treatment of paraesophageal hiatal hernias. Materials and methods. During the period of 2012-2014, at the clinic of faculty surgery, on the basis of abdominal surgery unit of City Clinical Hospital №21, nine patients with paraesophageal hernias containing not less than 50 % of the stomach underwent laparoscopic surgery. At the stage of preoperative examination, complex of the generally accepted methods included magnetic resonance tomography of diaphragam and monometry of lower esophageal sphincter. Results. Laparoscopic surgical treatment consisted of complete excision of the hernial pouch, crurography, prosthetic plasty of diaphragm crura with the area of hernial defect in the diaphragm more than 4 cm 2 followed by peritonization of the net using hernia pouch fragment, fundoplication. Patients with colonic paraesophageal hernia did not experience fundoplication. A mean time of the operation was 110 minutes. No intraoperative, early, late postoperative complications were observed. Conclusions. Laparoscopic surgical treatment of paraesophageal hernias is a safe method, but some details and technique of operative means remain the issue of discussion: for example, is it always necessary to carry out fundoplication in case of surgical treatment of paraesophageal hernias, what technique of diaphragm plasty is an optimal one.