The methods of improvement in the results of Nissen’s laparoscopic fundoplication for hiatal hernias

Abstract

Minimally invasive techniques, namely laparoscopic fundoplication (LFP) by Nissen has been increasingly used for the correction of hiatal hernias due to a range of advantages. However, LFP is frequently associated with postoperative complications. As many authors noted, those complications might be related to wrong trocar placement as result of non-individual approach to patients. We aimed to determine the optimal trocar insertion zones for LFP by Nissen, considering the physique of patients.

All 44 patients were divided into two clinical groups. The control group included 21 patients who underwent standard treatment LFP by Nissen’s technique. In the main group of 23 patients during the preformation of LFP trocar insertion points were determined according to the calculations of a computer program developed by us.

In the control group, duration of LFP in patients with normosthenic and asthenic physique was on average 125±15 minutes, with hypersthenic - 185±27 minutes (on average in the control group - 170±22 minutes). The main duration of LFP was 110±10 minutes, with hypersthenic – on average 140±14 minutes (on average, 125±12 minutes in the main group). In this case, the patients with BMI greater than 30 kg/cm² the operation duration reduced by 45 minutes. There were no intraoperative complications.

Thus, the effectiveness of the developed software for LFP was validated by decreasing the frequency of intra- and postoperative complications. It caused shortening the duration of surgery and postoperative hospital stay, especially in patients with morbid obesity.