scholarly journals ROLE AND PLACE OF ULTRASONOGRAPHY IN DIAGNOSTICS OF ADHESIVE INTESTINAL OBSTRUCTION

2020 ◽  
Vol 73 (1) ◽  
pp. 83-86
Author(s):  
Vadim B. Borisenko ◽  
Artem N. Kovalev ◽  
Tatyana А. Denysiuk
Keyword(s):  
Surgical Treatment ◽  
Intestinal Obstruction ◽  
Conservative Therapy ◽  
Ray Method ◽  
Transabdominal Ultrasonography ◽  
X Ray ◽  
Abdominal Organs ◽  
Ultrasound Study ◽  
Treatment Indications ◽  
Adhesive Intestinal Obstruction

The aim: To study the possibilities of ultrasound in adhesive ileus obstruction diagnosis and indications for surgical treatment determination. Materials and methods: The results of diagnosis and treatment of 60 patients with acute adhesive intestinal obstruction with comparative use of X-ray and ultrasound methods were analyzed. Results: The use of a standard X-ray examination of the abdominal organs upon admission to the hospital allowed the diagnosis of acute adhesions of small bowel obstruction in only 32 (53.3%) patients. Transabdominal ultrasonography allowed the establishment of adhesive ileus during hospitalization in 53 (88.3%) patients and also in 7 (11.7%) during a dynamic examination 2-3 hours after admission. Due to the lack of positive effect from the conducted conservative therapy relying on the data of ultrasound studies, 33 (55%) patients were operated on. During X-ray examination, only 10 (30.3%) of these patients demonstrated negative X-ray dynamics, and with an ultrasound study, deterioration of echo pictures was observed in all 33 (100%) patients. Conclusions: Compared with the X-ray method, transabdominal ultrasonography is established to be safe, affordable, simpler, non-invasive and highly informative method for the study of acute adhesions of the small intestinal obstruction. The method allows the assessment of the ongoing conservative therapy dynamics and determination for surgical treatment indications.

scholarly journals About criteria of X-Ray study in chronic palace disease of Bruceur

2018 ◽  
Vol 11 (2) ◽  
pp. 97-100
Author(s):  
Marat A Nurtdinov ◽  
Ildar F Sufiayrov ◽  
Gusel R Yamalova ◽  
Aiaz A Shakirianov
Keyword(s):  
Small Intestine ◽  
Surgical Treatment ◽  
Intestinal Obstruction ◽  
Intestinal Wall ◽  
Virtual Model ◽  
Peritoneal Adhesion ◽  
Peritoneal Disease ◽  
X Ray ◽  
Pearson Criterion ◽  
Adhesive Intestinal Obstruction

The problem of determining indications for surgical treatment for peritoneal peritoneal disease is relevant in connection with the lack of reliable criteria that allow us to detect intestinal obstruction at early stages. The authors studied the x-ray picture of chronic peritoneal peritoneal disease in two groups of patients, without obstruction (6 patients) and in the group of patients with obstruction (5 patients). X-ray computer tomography diagnostics was carried out using the Aquilion RXL, Toshiba Japan, VitreaAdvanced software was used to build the virtual model. For the comparative analysis, nonparametric statistics were used to calculate the Pearson criterion, with the Yates correction. The authors proposed the criteria of X-ray tomographic examination, which allow differentiating the adhesive intestinal obstruction from exacerbation of peritoneal adhesion. To these signs, the authors refer, pneumatized loops of the intestine, the presence of fluid in the lumen of the small intestine, the accumulation of fluid more than 200.0 ml, in two or more areas, thickening of the intestinal wall more than 2.1 mm. It was shown that the use of the developed complex of symptoms in the diagnosis of the disease positively affects the results of surgical treatment.

scholarly journals CAUSES OF EARLY RELAPAROTOMIES IN SURGERY

2021 ◽  
pp. 77-80
Author(s):  
V. I. Lupaltsov ◽  
K. O. Vander
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Intestinal Obstruction ◽  
Early Postoperative Period ◽  
Early Postoperative Complications ◽  
Urgent Surgery ◽  
Abdominal Abscesses ◽  
Abdominal Organs ◽  
Adhesive Intestinal Obstruction ◽  
Suture Failure

Summary. Introduction. Despite the introduction of modern methods of diagnosis, tactics, and treatment of diseases of the abdominal organs, the risk of developing early postoperative complications remains high. The aim of this study is to clarify the causes of early postoperative complications and indications for their surgical treatment. Materials and methods. 3947 case histories of patients operated on for urgent indications were analyzed. In 73 cases, relaparotomies were performed in the early postoperative period (1.85 %). Results and discussion. The main nosologic unit, during the surgical treatment of which relaparotomies were performed, was acute appendicitis. Then there was a perforated pyloroduodenal ulcer and a strangulated hernia of various localization. The main indications for relaparotomy were progressive peritonitis, early adhesive intestinal obstruction, intra-abdominal abscesses, and infiltrates. In two cases, no pathology was detected during relaparotomy – there was an over diagnosis of postoperative peritonitis and anastomotic suture failure. Conclusion. 1. The main cause for relaparotomies in urgent surgery is the progression of preoperative peritonitis. 2. The second important cause is early postoperative adhesive intestinal obstruction. 3. Errors in intraoperative diagnostics, tactics, and techniques are the third leading cause of early relaparotomies.

scholarly journals OBTURATION INTESTINAL OBSTRUCTION IN THE COURSE OF NECROTIZING ENTEROCOLITIS IN NEWBORN CHILDREN

2021 ◽  
Vol 74 (4) ◽  
pp. 838-841
Author(s):  
Olga M. Gorbatyuk ◽  
Stanislav I. Babuci ◽  
Taras V. Martinyuk ◽  
Konstantin T. Bertsun
Keyword(s):  
Intestinal Obstruction ◽  
Conservative Therapy ◽  
Intestinal Anastomosis ◽  
Abdominal Cavity ◽  
Clinical Manifestations ◽  
Wall Thickening ◽  
Free Fluid ◽  
Contrast Study ◽  
X Ray ◽  
Abdominal Organs

The aim: To analyze our own results of diagnosis and treatment of newborns with NEC and obturation intestinal obstruction in order to determine theoretically important and practically significant recommendations on this issue, to optimize preventive measures for reducing intestinal obstruction cases in NEC and improving treatment outcome among newborns. Materials and methods: Our supervision involved 143 newborns with NEC for the period from 2006 to 2020, including 79 boys (55.24%) and 64 girls (44.76%). Gestational age was 26-42 weeks. The majority of children were premature infants and numbered 121 children (84,62%). The assessment of clinical manifestations, progression of the disease, physical examination of newborns were used to help in diagnosing. All children underwent general clinical tests and instrumental methods of diagnosis including ultrasonography (abdominal organs and retroperitoneum, echocardiography, neurosonography) and X-ray examination (two-dimensional plain abdominal radiography, X-ray contrast study of the gastrointestinal tract). According to the survey, all patients were examined by allied health professionals. Results: Obturation intestinal obstruction associated with NEC was diagnosed in 26 children (18.18%). 12 children were in serious condition, representing 46.15%. The condition of other 14 children (53.85%) was assessed as critical one. The first signs of intestinal obstruction were observed in children with NEC at the end of the first week or at the beginning of the second week of life. Intestinal obstruction was acute in 21 children (80.77%); 5 children (19.23%) had relapsing course. Blood test results showed the inflammatory process and were not specific. According to the results of our observation, the dynamics of platelets is indicative as there is a correlation between the deterioration in the child’s condition and the onset of symptoms of intestinal obstruction and thrombocytopenia. There was an imbalance in protein and electrolyte metabolism – a decrease in the level of albumin, indicators of K, Na, Ca, and an increase of C-reactive protein by several times. Ultrasonography of the abdominal organs showed irregular intestinal pneumatization, dilated intestinal loops with stagnant intestinal contents, pendulum peristalsis, infiltrative bowel wall thickening, free fluid in the abdominal cavity. Plain radiography revealed typical manifestations of small intestinal obstruction with multiple air-fluid levels. In 15 newborns (57.69%), conservative treatment was effective, in particular intestinal obstruction was relieved; 11 newborns (42.31%) underwent surgery. The mortality was 36.36% (4 children died). Postoperative complication in the form of bowel stenosis in the area of the direct anastomosis was observed in 3 patients approximately 2 weeks after the surgery. Conclusions: 1. NEC can lead to the development of obturation intestinal obstruction in newborns. Obturation intestinal obstruction was a form of NEC course in 18.18% of children under our observation. 2. Obturation intestinal obstruction in NEC in newborns is a reversible condition and requires conservative therapy. If symptoms of obstruction persist within 3 days after the start of conservative therapy, surgical treatment is indicated. 3. In case of obturation intestinal obstruction, it is advisable to perform resection of necrotic bowel, formation of a double enterostomy. 4. Enterostomy closure by placing T-shaped intestinal anastomosis should be performed 4 weeks after the primary surgery. 5. The use of modern techniques for early diagnosis and timely treatment of obturation intestinal obstruction in NEC can reduce mortality and the number of postoperative complications. 6. Newborns with NEC should be under the supervision of surgeons, which will help timely determine the indications for surgical intervention.

scholarly journals Comparison of Conservative and Operative Treatment of Jones Fracture

2019 ◽  
Author(s):  
Jiri Demel ◽  
Ladislav Planka ◽  
Radek Stichhauer ◽  
Leopold Pleva
Keyword(s):  
Surgical Treatment ◽  
Fracture Healing ◽  
Conservative Therapy ◽  
Aofas Score ◽  
X Ray ◽  
Jones Fracture ◽  
Conservative And Operative Treatment ◽  
O 15 ◽  
K 12 ◽  
Type Of Fracture

Abstract Background: A Jones fracture is a transverse fracture of the V. metatarsal bone, without significant dislocation in the diaphysis junction and metaphyseal metaphysis. This type of fracture is usually associated with a minimal injury mechanism, and is characterized with minimal swelling, absence of hematoma and prolonged healing. The aim of the presented study was to compare the surgical and conservative therapy of Jones fracture. The study was registered in the www.clinicaltrials.gov database, under the ClinicalTrials.gov ID: NCT04037540 on 27th July 2019. Methods: A total of 27 study subjects were randomized into two groups – Conservative (K): 12, and Operational (O): 15. The study subjects were followed after 6 and 12 weeks using X-ray and the American Orthopedic Foot and Ankle Score (AOFAS). In the absence of X-ray signs of healing and low AOFAS score in Group K, treatment was considered unsuccessful and the patient was indicated for surgical treatment. Results: Five patients in Group K showed no signs of healing on X-ray after 12 to 6 weeks. These patients also manifested poor AOFAS scores and were indicated for surgical treatment and excluded from the study. Fracture failure was observed in seven patients. Their AOFAS scores were at the least satisfactory and, the patients continued in conservative therapy. After 12 weeks, 6 patients manifested fracture healing on X-ray and the AOFAS score of 100. In one patient who refused surgery, the fracture was not healed after 12 weeks. In Group O, seven patients achieved fracture healing on X-ray after 6 weeks, 8 patients did not show fracture healing. The average AOFAS score after 6 weeks was 97 (excellent). After 12 months, 13 patients showed findings of fracture healing on X-ray. The average AOFAS score was 100 points (maximum). Conclusions: The results of the study show that 1) Surgical treatment leads to significantly faster signs of healing on X-ray than the conservative one 2) After six weeks of surgery, 93% (14 out of 15) of patients are able to fully load the limb. Keywords: Jones - Fracture - AOFAS - Herbert screw Unique protocol ID: FNO-KUCH-01-Jones

scholarly journals The Point-Rating Scale for Determining Treatment Tactics in Patients With Adhesive Small Bowel Obstruction

2021 ◽  
Vol 10 (2) ◽  
pp. 303-308
Author(s):  
B. V. Sigua ◽  
V. P. Zemlyanoy ◽  
B. P. Filenko ◽  
P. A. Kotkov ◽  
D. Kh. Kalandarova ◽  
...  
Keyword(s):  
Intestinal Obstruction ◽  
Conservative Therapy ◽  
Rating Scale ◽  
Negative Impact ◽  
Morphological Changes ◽  
Abdominal Cavity ◽  
Adhesive Small Bowel Obstruction ◽  
Point Rating Scale ◽  
Adhesive Intestinal Obstruction ◽  
Therapy Success

Relevance. The most practiced method of treating patients with acute intestinal obstruction - urgent surgical intervention - does not guarantee remission, contributing to the progression of morphological changes in the abdominal cavity. From this perspective, a shift in emphasis towards the planned surgical treatment of patients with adhesive disease with the use of the existing anti-adhesive methods after conservative resolution of the intestinal passage disorders looks like a promising direction.Aim of the study. Improving the results of patients with acute adhesive intestinal obstruction treatment by developing a point-rating scale that allows to highlight groups of patients who are prone to conservative resolution of intestinal passage disorders episode, and, thereby, reduces the proportion of urgent interventions.Material and methods. The analysis of the 125 patients treatment results (retrospective group) admitted with symptoms of acute adhesive intestinal obstruction was carried out. On this basis, the point-rating scale was developed including a number of factors that have certain value in terms of predicting the probability of conservative therapy success. Subsequently the developed scale was applied in 170 patients (prospective group) as part of treatment tactics implementation aimed at maximally conservative resolution of adhesive intestinal obstruction without negative effect on the immediate results of patients operated in later periods.Results. The developed point-rating scale made it possible to reduce the frequency of urgent interventions among patients with signs of acute adhesive intestinal obstruction (from 79.2% to 57.6%) due to longer conservative measures — 18.1±17.2 and 11,2±8.7 hours in prospective and retrospective groups, respectively). There was no negative impact on the frequency of resection interventions (12.2 and 16.1% in the prospective and retrospective groups) as well as postoperative complications and overall mortality.Conclusions. The developed point-assessment scale made it possible to stratify patients in accordance with the probability of conservative therapy success and to justify its continuation for more than 12 hours in low-risk patients. The obtained results allow us to recommend the proposed scale for use in clinical practice. 

scholarly journals Modern methods for adhesive bowel obstruction diagnosis

2021 ◽  
Author(s):  
K. D. Rybakov ◽  
G. S. Sednev ◽  
E. M. Askerov ◽  
A. M. Morozov ◽  
A. N. Pichugova ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Small Intestine ◽  
Small Bowel ◽  
Intestinal Obstruction ◽  
Resonance Imaging ◽  
X Ray ◽  
Modern Methods ◽  
Partial Colectomy ◽  
Adhesive Intestinal Obstruction

Topicality. Adhesive intestinal obstruction is a common disease in abdominal surgery with a significant increase from year to year. During the last 20 years, the frequency of cases of adhesive intestinal obstruction (SCN) has increased by 2 times and has no tendency to decrease. In the UK, small bowel obstruction was an indication for 51% of all emergency laparotomies. Scott et al. reported seven emergency surgeries, accounting for 80% of all hospital admissions, morbidity, mortality, and health care costs in relation to general surgery in the United States. These seven operations included partial colectomy, small bowel resection, cholecystectomy, peptic ulcer surgery, adgeolysis, appendectomy, and laparotomy. Adhesive intestinal obstruction of the small intestine was the most frequent diagnosis in the behavior of four out of seven surgical interventions (partial colectomy, resection of the small intestine, adgeolysis and laparotomy). Postoperative adhesive processes are the main cause of small intestine obstruction, accounting for 60% of cases. Among all cases of intestinal obstruction, acute small intestine is 64.3–80%, while having a severe course and a worse prognosis. This causes a high mortality rate in this pathology. It ranges from 5.1% to 8.4%, occupying a leading place among all urgent diseases.The purpose of the study was to evaluate various modern methods of diagnosing adhesive intestinal obstruction.Material and methods. In this study, the method of classical analysis of domestic and foreign literature was applied, based on current data on the diagnosis of adhesive intestinal obstruction.Results. Historically, there has been a certain algorithm for examining patients arriving with suspected adhesive intestinal obstruction, which includes: complaints, anamnesis of the disease and life, objective status, as well as additional diagnostic methods. Patients with OCD usually present a wide range of complaints, such as nausea, vomiting and periodic abdominal pain. Nausea and vomiting follow the appearance of pain and are an early sign of proximal adhesive OCN. However, clinical symptoms are only partially able to diagnose adhesive intestinal obstruction. Laboratory data are of little significance in the diagnosis of intestinal obstruction, but they help to determine the presence and severity of metabolic disorders, homeostasis disorders, as well as to indicate possible starngulation. For the diagnosis of OCN, OBP survey radiography is routinely used. Computed tomography (CT) has a higher sensitivity and specificity compared to abdominal X-ray examination and is recommended by the Bologna Guidelines. Ultrasound examination (ultrasound) is increasingly used in the diagnosis of OCD. Ultrasound is a relatively simple inexpensive non-invasive imaging method that is devoid of radiation exposure, but depends on the operator's experience. To minimize the effects of ionizing radiation in children and pregnant women, magnetic resonance imaging is an effective alternative to computed tomography for intestinal obstruction.Conclusion. The problem of adhesive intestinal obstruction remains highly relevant, given the prevalence of the disease and high mortality rates. Currently, new promising methods for diagnosing this disease, including biomarkers and high-tech methods for visualizing the pathological process, such as computed tomography and magnetic resonance imaging, are acquiring high importance. At the same time, one should not forget about the routine research methods – X-ray of the abdominal cavity and classical methods of examining the patient – collecting complaints, anamnesis and determining the objective status. 

scholarly journals APPENDICULAR PERITONITIS IN CHILDREN: AN EFFICIENT SURGICAL APPROACH AND INTENSIVE CARE

2020 ◽  
Vol 24 (2) ◽  
pp. 62-70
Author(s):  
O. V. Karaseva ◽  
Kseniia E. Utkina ◽  
A. L. Gorelik ◽  
A. V. Timofeeva ◽  
D. E. Golikov ◽  
...  
Keyword(s):  
Intensive Care ◽  
Laparoscopic Surgery ◽  
Surgical Treatment ◽  
Postoperative Complications ◽  
Intestinal Obstruction ◽  
Postoperative Period ◽  
Diffuse Peritonitis ◽  
Surgical Tactics ◽  
Adhesive Intestinal Obstruction ◽  
Local Protocol

Introduction. Currently, there is no any unified approach to the treatment of complicated forms of acute appendicitis in children. The purpose of our study is to evaluate the effectiveness of the local Protocol for diagnostics and treatment of appendicular peritonitis (AP) in children. Material and methods. 149 children with AP, aged 2 - 17 (11 ± 3.5 ), were included into the study. All of them were treated at the Clinical and Research Institute Emergency Pediatric Surgery and Trauma (CRIEPST) in 2015-2018. In the gender structure, boys (104; 69.8%) prevailed over girls (45; 30.2%). The following parameters were evaluated: AP structure, surgical tactics, postoperative course (incidence of postoperative intestinal failure syndrome (IFS), postoperative complications, length of hospital stay). A tactics for surgical treatment and volume of intensive care in the postoperative period were defined depending on AP severity and according to the local Protocol. Laparoscopic appendectomy was performed in 145 (97.3%) patients. There were no intraoperative complications and conversions in the studied group. In case of periappendiular abscess (PA) 3 (2.7%), patients had puncture and abscess drainage under ultrasound control. Results. While analyzing the AP structure by forms , the following picture was shown: free and abscessed forms were approximately equal - 72 (48.3%) and 77 (51.7%), respectively (p > 0.05). Diffuse peritonitis - 31.5%; generalized - 16.8%; combined - 17.4%; periappendicular abscess (PA) stage 1-14.8%; PA 2-16.8%; PA 3-2.7%. Postoperative complications - 4 (2.7%): postoperative abdominal abscesses - 3 (2.0%); early adhesive intestinal obstruction - 1 (0.7%). In postoperative abscesses, puncture and drainage were performed under ultrasound control; in early adhesive intestinal obstruction - laparoscopic adhesiolysis. All the children recovered. Length of intensive care was 2.9 ± 1.8 days; hospitalization - 12.0 ± 5.2 days. Conclusion. The local Protocol developed by the researchers helps to define a surgical tactics and volume of intensive care in the postoperative period. Laparoscopic surgery, in the vast majority of cases, is an optimal and effective technique for AP surgical treatment in children. Contraindications to laparoscopic surgery are PA 3 and total abscessing peritonitis.

scholarly journals DIAGNOSTICS AND COMPLEX TREATMENT OF ADGHESIVE INTESTINAL OBSTRUCTION

2019 ◽  
pp. 59-62
Author(s):  
V. B. Bоrisenko ◽  
А. М. Kovalev
Keyword(s):  
Polyethylene Glycol ◽  
Surgical Treatment ◽  
Intestinal Obstruction ◽  
Clinical Laboratory ◽  
Hypotonic Solution ◽  
Polyethylene Glycol 4000 ◽  
Treatment And Prevention ◽  
Ultrasound Diagnostics ◽  
Adhesive Intestinal Obstruction ◽  
Adhesive Obstruction

Summary: Develop a comprehensive program for the diagnosis, treatment and prevention of intestinal adhesive obstruction.  Analyzed the results of diagnosis and treatment of 60 patients with acute adhesive intestinal obstruction. The diagnostic program included clinical, laboratory, X-ray and ultrasound diagnostics. Local barrier prevention of peritoneal adhesive disease was performed with a solution of polyethylene glycol 4000 according to the method developed by us. Conservative therapy was effective in 19 (31.7%) cases. 41 (68.3%) patients with a progression of adhesive ileus were operated. Laparoscopic adheolysis was performed in 4 (9.8%) patients. In 37 (90.2%) cases, surgical treatment was performed in the traditional method. The proposed diagnostic and treatment program with priority use of ultrasound diagnostics allows in a short time to establish a detailed diagnosis of adhesive intestinal obstruction and to determine the indications for surgical treatment. Intraoperative use of hypotonic solution polyethylene glycol 4000 allows to reliably prevent the development of peritoneal adhesive disease and adhesive obstruction.

scholarly journals Principles of surgical treatment of recurrent hiatal hernias (review of literature)

2020 ◽  
Vol 26 (3) ◽  
pp. 20-24
Author(s):  
G. T. Bechvaya ◽  
D. I. Vasilevsky ◽  
A. M. Ahmatov ◽  
V. V. Kovalik
Keyword(s):  
Surgical Treatment ◽  
Gastroesophageal Reflux ◽  
Motor Skills ◽  
Surgical Interventions ◽  
Large Size ◽  
Abdominal Organs ◽  
Alternative Approach ◽  
Treatment Indications ◽  
Life Threatening ◽  
Recurrent Hiatal Hernia

Recurrent hiatal hernia is the re-displacement of the abdominal organs into the chest after surgical treatment. Indications for repeated surgical interventions for this pathology are resistant to medical correction gastroesophageal reflux or anatomical disorders, bearing the risk of developing life-threatening conditions. The key task of revision interventions is to identify and address the causes of the failure of the primary operation. The main factors of the recurrence of hernias of this localization are the large size of the hiatal opening, the mechanical weakness of the legs of the diaphragm and the shortening of the esophagus. To increase the reliability of the esophageal aperture plasty in the surgical treatment of recurrent hiatal hernias, prosthetic materials are widely used. When the esophagus is shortened, it is possible to increase its length by creating a gastric stalk (gastroplasty) or fixing the stomach to the anterior abdominal wall (gastropexy). The disadvantage of both methods is the occurring functional impairment. An alternative approach is the formation of a fundoplication wrap in the chest with the closure of the esophageal opening only with its own tissues. To eliminate or prevent the development of gastroesophageal reflux, antireflux reconstruction is an essential component of operations for recurrent hiatal hernias. The option of fundoplication is selected in accordance with the contractility of the esophagus. With normokinesia, circular fundoplication was preferred, with impaired motor skills – free reconstructions.

scholarly journals Recurrent hiatal hernias. To operate or not?

2020 ◽  
Vol 11 (5) ◽  
pp. 31-35
Author(s):  
Dmitry I. Vasilevsky ◽  
Georgy T. Bechvaya ◽  
Akhmat M. Ahmatov ◽  
Andrey Yu. Korolkov ◽  
Alexander A. Smirnov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hiatal Hernia ◽  
Recurrent Hernia ◽  
Initial Position ◽  
Long Term Results ◽  
Prosthetic Material ◽  
Scientific Discussion ◽  
Abdominal Organs ◽  
Treatment Indications ◽  
Functional Factors

The recurrence of a hiatal hernia after surgical treatment is the most serious and far from resolved problem in this area of surgery. The validity and effectiveness of surgical treatment of recurrent hiatal hernia of the diaphragm remains the subject of clinical research and scientific discussion. The main problems of such interventions are the difficulty of eliminating the anatomical or functional factors that underlie the failure of the primary operation. The stated provisions determine the need for further searches for a solution of this problem. In the period from 2015 to 2020, 61 patients with recurrent hernia of the gastrointestinal orifice of the diaphragm underwent surgical treatment. Indications for the operation were gastroesophageal reflux refractory to drug therapy or anatomical changes that carry the risk of developing life-threatening conditions. In 58 (95.1%) cases, surgery was performed laparoscopically, in 3 (4.9%) through left-side thoracotomy. In 54 (88.5%) cases, complete restoration of normal anatomy with closure of the hiatal opening with prosthetic material is performed. In 7 (11.5%) cases, when the esophagus was shortened, the fundoplication cuff was created in the chest cavity, and the hiatal opening was performed only with its own tissues. Complications occurred in 11 (18.0%) cases (7 pneumothorax, 2 bleeding, 2 perforation of a hollow organ). Long-term results (12-48 months) were evaluated in 57 (93.4% of operated) people. Repeated recurrence of hiatal hernia of the diaphragm was detected in 6 (10.5%) cases. In 44 (77.2%) cases, the natural anatomical position of the abdominal organs was documented. In 7 (12.3%) patients, with a fundoplication cuff formed in the chest, its initial position was ascertained.

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