Evaluation of antireflux surgery effectiveness in patients with hiatal hernia





hiatal hernia, laparoscopy, fundoplication, cruroplasty, alloplasty


The generally accepted gold standard in the surgical treatment of hiatal hernias is laparoscopic fundoplication with cruroplasty. At the same time, the problem of choosing the best method of fundoplication to improve the results of surgical intervention remains disputable.

Aim. Determination of the effectiveness of antireflux interventions and the frequency of postoperative dysphagia in patients with esophageal hernia.

Materials and methods. The results of 38 patients in the early and late postoperative period, operated with the use of Nissen and Toupet fundoplication, with an integrated exhaustive examination of the manifestations of dysphagia syndrome were analyzed. 17 (44.7 %) patients (first group) underwent laparoscopic posterior crurorraphy with Nissen fundoplication in the Short-Floppy-Nissen modification, and 21 (55.3 %) patients (second group) underwent posterior crurorraphy with Toupet fundoplication.

Results. In the postoperative period, the intensity of pain on the rating scale was minimal in 70.6 % and 71.4 %; moderate in 23.5 % and 14.3 %; strong in 5.9 % and 14.3 % of the patients in the first and second groups, respectively. The first degree of dysphagia (the ability to ingest liquid food and fluids) was observed in 5 of 17 (29.4%) patients of the first group, with subsequent regression in 4 of 5 patients within 5 days; in the second group there was no dysphagia. When comparing the results of all scales of integrated analysis of the quality of life of the patients of both groups, no significant difference was found between them.

Conclusions. The obtained data demonstrate the compatibility of both methods, in the absence of differences in quality of life and patient’s satisfaction in the late postoperative period. Differences in the frequency of dysphagia syndrome after surgery indicate the need for a more differentiated approach to the choice of fundoplication technique.

Author Biographies

A. V. Klymenko, Zaporizhzhia State Medical University, Ukraine

MD, PhD, DSc, Professor of the Department of Faculty Surgery

B. S. Kravchenko, Zaporizhzhia State Medical University, Ukraine

MD, PhD, Assistant of the Department of Faculty Surgery

V. M. Klymenko, Zaporizhzhia State Medical University, Ukraine

MD, PhD, DSc, Professor of the Department of Hospital Surgery

L. N. Serhieieva, Zaporizhzhia State Medical University, Ukraine

PhD, DSc, Professor of the Department of Medical Physics, Biophysics and Further Mathematics

S. M. Kravchenko, Surgical Center of the “Motor Sich” Clinic, Zaporizhzhia, Ukraine

MD, PhD, Head of the Surgical Center

V. S. Tkachov, Zaporizhzhia State Medical University, Ukraine

PhD student, Senior Laboratory Assistant of the Department of Faculty Surgery


Reynolds, J. L., Zehetner, J., Nieh, A., Bildzukewicz, N., Sandhu, K., Katkhouda, N., & Lipham, J. C. (2016). Charges, outcomes, and complications: a comparison of magnetic sphincter augmentation versus laparoscopic Nissen fundoplication for the treatment of GERD. Surgical endoscopy, 30(8), 3225-3230. https://doi.org/10.1007/s00464-015-4635-6

Neuvonen, P., Sand, J., Matikainen, M., & Rantanen, T. (2017). Does Nissen Fundoplication Provide Lifelong Reflux Control? Symptomatic Outcome After 31-33 Years. World journal of surgery, 41(8), 2046-2052. https://doi.org/10.1007/s00268-017-3924-8

Schwameis, K., Zehetner, J., Rona, K., Crookes, P., Bildzukewicz, N., Oh, D. S., Ro, G., Ross, K., Sandhu, K., Katkhouda, N., Hagen, J. A., & Lipham, J. C. (2017). Post-Nissen Dysphagia and Bloating Syndrome: Outcomes After Conversion to Toupet Fundoplication. Journal of gastrointestinal surgery, 21(3), 441-445. https://doi.org/10.1007/s11605-016-3320-y

Le Page, P. A., Furtado, R., Hayward, M., Law, S., Tan, A., Vivian, S. J., Van der Wall, H., & Falk, G. L. (2015). Durability of giant hiatus hernia repair in 455 patients over 20 years. Annals of the Royal College of Surgeons of England, 97(3), 188-193. https://doi.org/10.1308/003588414X14055925060839

Grubnik, V., Grubnik, V., & Paranyak, M. (2020). Povtorni laparoskopichni antyrefliuksni operatsii u patsiientiv z hryzhamy stravokhidnoho otvoru diafrahmy [Redo laparoscopic antireflux surgery in patients with hiatal hernia]. Kharkiv Surgical School, (3), 36-39. [in Ukrainian]. https://doi.org/10.37699/2308-7005.3.2020.07

Pasalich, D. S., Witkiewitz, K., McMahon, R. J., Pinderhughes, E. E., & Conduct Problems Prevention Research Group (2016). Indirect Effects of the Fast Track Intervention on Conduct Disorder Symptoms and Callous-Unemotional Traits: Distinct Pathways Involving Discipline and Warmth. Journal of abnormal child psychology, 44(3), 587-597. https://doi.org/10.1007/s10802-015-0059-y

Brown, A. M., Nagle, R., Pucci, M. J., Chojnacki, K., Rosato, E. L., & Palazzo, F. (2019). Perioperative Outcomes and Quality of Life after Repair of Recurrent Hiatal Hernia Are Compromised Compared with Primary Repair. The American surgeon, 85(5), 556-560.

Sheiko, V. D., Krishanovsky, O. A., Kaliuzhka, A. S., Dolzhkovyi, S. V., Sytnik, D. A., & Shkurupiy, O. A. (2020). Parakhiatalni hryzhi u strukturi hryzh dilianky stravokhidnoho otvoru diafrahmy [Parahiatal hernia in structure of hernias in region of esophageal diaphragmatic hiatus]. Klinicheskaia Khirurgiia, 87(3-4), 74-77. [in Ukrainian]. https://doi.org/10.26779/2522-1396.2020.3-4.74

Huddy, J. R., Markar, S. R., Ni, M. Z., Morino, M., Targarona, E. M., Zaninotto, G., & Hanna, G. B. (2016). Laparoscopic repair of hiatus hernia: Does mesh type influence outcome? A meta-analysis and European survey study. Surgical endoscopy, 30(12), 5209-5221. https://doi.org/10.1007/s00464-016-4900-3

Usenko, A., Tyvonchuk, O., Dmytrenko, О., Tereshkevych, I., & Babii, I. (2021). Suchasni aspekty likuvannia hryzhi stravokhidnoho otvoru diafrahmy ta yii osnovnykh uskladnen [Modern aspects of treatment of hiatal hernia and its main complications]. Zaporozhye medical journal, 23(2), 207-213. [in Ukrainian]. https://doi.org/10.14739/2310-1210.2021.2.209629

Prassas, D., Krieg, A., Rolfs, T. M., & Schumacher, F. J. (2017). Long-term outcome of laparoscopic Nissen fundoplication in a regional hospital setting. International journal of surger, 46, 75-78. https://doi.org/10.1016/j.ijsu.2017.08.580

Moore, M., Afaneh, C., Benhuri, D., Antonacci, C., Abelson, J., & Zarnegar, R. (2016). Gastroesophageal reflux disease: A review of surgical decision making. World journal of gastrointestinal surgery, 8(1), 77-83. https://doi.org/10.4240/wjgs.v8.i1.77

Du, X., Hu, Z., Yan, C., Zhang, C., Wang, Z., & Wu, J. (2016). A meta-analysis of long follow-up outcomes of laparoscopic Nissen (total) versus Toupet (270°) fundoplication for gastro-esophageal reflux disease based on randomized controlled trials in adults. BMC gastroenterology, 16(1), 88. https://doi.org/10.1186/s12876-016-0502-8

Rona, K. A., Reynolds, J., Schwameis, K., Zehetner, J., Samakar, K., Oh, P., Vong, D., Sandhu, K., Katkhouda, N., Bildzukewicz, N., & Lipham, J. C. (2017). Efficacy of magnetic sphincter augmentation in patients with large hiatal hernias. Surgical endoscopy, 31(5), 2096-2102. https://doi.org/10.1007/s00464-016-5204-3

Asti, E., Lovece, A., Bonavina, L., Milito, P., Sironi, A., Bonitta, G., & Siboni, S. (2016). Laparoscopic management of large hiatus hernia: five-year cohort study and comparison of mesh-augmented versus standard crura repair. Surgical endoscopy, 30(12), 5404-5409. https://doi.org/10.1007/s00464-016-4897-7

Fuchs, K. H. (2020). Definition and Pathophysiology of Gastroesophageal Reflux Disease. In S. Horgan, K. H. Fuchs (Eds.), Management of Gastroesophageal Reflux Disease (pp. 1-17). Springer, Cham. https://doi.org/10.1007/978-3-030-48009-7_1

Chandrasoma, P. (2021). Pathophysiology of Lower Esophageal Sphincter Damage: A New Method of Diagnosis of Gastroesophageal Reflux Disease. In S. F. Schoppmann, M. Riegler (Eds.), Multidisciplinary Management of Gastroesophageal Reflux Disease (pp. 1-32). Springer, Cham. https://doi.org/10.1007/978-3-030-53751-7_1

Tian, Z. C., Wang, B., Shan, C. X., Zhang, W., Jiang, D. Z., & Qiu, M. (2015). A Meta-Analysis of Randomized Controlled Trials to Compare Long-Term Outcomes of Nissen and Toupet Fundoplication for Gastroesophageal Reflux Disease. PloS one, 10(6), e0127627. https://doi.org/10.1371/journal.pone.0127627

Analatos, A., Lindblad, M., Ansorge, C., Lundell, L., Thorell, A., & Håkanson, B. S. (2022). Total versus partial posterior fundoplication in the surgical repair of para-oesophageal hernias: randomized clinical trial. BJS open, 6(3), zrac034. https://doi.org/10.1093/bjsopen/zrac034

Ireland, A. C., Holloway, R. H., Toouli, J., & Dent, J. (1993). Mechanisms underlying the antireflux action of fundoplication. Gut, 34(3), 303-308. https://doi.org/10.1136/gut.34.3.303



How to Cite

Klymenko AV, Kravchenko BS, Klymenko VM, Serhieieva LN, Kravchenko SM, Tkachov VS. Evaluation of antireflux surgery effectiveness in patients with hiatal hernia. Pathologia [Internet]. 2023Jan.27 [cited 2024Apr.17];19(3):183-8. Available from: http://pat.zsmu.edu.ua/article/view/253116



Original research