SURGICAL TACTICS FOR LARGE AND GIANT ESOPHAGEAL HIATAL HERNIA

The  OBJECTIVE  is to improve  the  results of surgical  treatment of patients with large  and  giant  EHH. MATERIAL AND METHODS.  We  present our  experience of surgical  treatment of 25  patients with large  and  giant  EHH, who  underwent laparoscopic  interventions according to  the  original  technique, which  consisted in the  method of plasty  of esophageal hiatus:   the   mesh  implant   was   installed   and   fixed  in  the   posterior  mediastinum  above  the   diaphragm.  RESULTS. Intraoperative  bleeding  was   noted   in  2  (8  %)  patients,  which  did  not  require   conversion.  In  the  near   postoperative period,   no  complications  were  noted.   In  the  long-term   periods from  1  to  5  years, there   was  no  recurrence of  EHH and  complications associated  with the  use   of mesh implant.  CONCLUSION.  Videoendosurgical  interventions  are  the operations  of  choice  in  the  treatment  of  patients  with  large  and  giant  EHH.  The  most  effective  method  of  plasty for  large  and  giant  EHH  is  the  combined plasty  of  the  esophageal hiatus   by  a  mesh implant  in  combination  with  a posterior  cruroraphy,  with  the  installation   and   fixation  of  the  mesh implant  in  the  posterior mediastinum above  the cruses of diaphragm.

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