A new approach to the treatment and classification of recurrent hiatal hernia and gastroesophageal reflux disease

Background. The incidence of disease relapse after primary antireflux surgical treatment ranges from 4 to 24 %, with up to 9 % of cases requiring revision surgery. Several studies demonstrate that the results of operations for recurrent hiatal hernia are less satisfactory compared to the primary procedure, especially after multiple interventions.
Aim. To propose a technique for laparoscopic redo fundoplication using a novel method, to evaluate short-term and long-term results after repeated surgical treatment of patients with recurrent hiatal hernia and GERD, and also to propose a classification of relapses of GERD and hiatal hernia.
Material and methods. The prospective study included data from 31 patients diagnosed with recurrent GERD and hiatal hernia. Laparoscopic redo fundoplication was used as a surgical method. Intraoperatively, technical errors of the previous operation were identified. The classification of relapses was conducted using the author’s method. Quality of life indicators using specialised questionnaires before surgery were: GERD-Q — 12.1 ± 2.82, GERD-HRQL — 26.12 ± 8.31, GSRS — 44.26 ± 10.21.
Results. There were no access conversions. The average duration of the operation was 141.21 minutes, blood loss was 81.40 ml, intraoperative complications in 4 (9.7 %) patients were eliminated intraoperatively, postoperative complications according to Clavien-Dindo ≥ 3 were diagnosed in one patient (pneumothorax), performed drainage of the pleural cavity. In 18 (58 %) patients, technical errors were identified that were made during the previous antireflux intervention. Quality of life indicators using specialised questionnaires six months after surgery were: GERD-Q — 2.1 ± 1.31, GERD-HRQL — 4.31 ± 2.98, GSRS — 17.02 ± 6.18. During the follow-up examination, 27 (87 %) patients noted complete recovery, as well as the absence of the need for PPI and prokinetic therapy.
Conclusion. The results of the study confirm the effectiveness, functionality and safety of laparoscopic redo fundoplication as the main treatment for this disease.

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