НАЗАД К УСЛУГАМLAPAROSCOPIC FOREGUT SURGERY

ГРЫЖА ПИЩЕВОДНОГО ОТВЕРСТИЯ

Anatomical hiatal repair and individualised reflux control, with careful preservation of swallowing function.

Автор медицинского материала: Efstratios K. KouroumpasСтраница обновлена: 30 августа 2026 г.

LAPAROSCOPICCRUROPLASTYNISSEN / TOUPET

Примечание: навигация по странице доступна на русском языке. Подробный медицинский текст этой специализированной страницы пока отображается на английском.

ELIXIS · ADVANCED CARE

Two goals: restore anatomy and control reflux while preserving function

Endoscopy, imaging and, when needed, manometry and 24-hour pH monitoring, with or without impedance, help guide the appropriate treatment.

СИМПТОМЫ

Symptoms that merit assessment

A hiatal hernia is an anatomical displacement of part of the stomach into the chest and may cause no symptoms. Gastro-oesophageal reflux is a separate condition that often coexists and causes many of the typical complaints.

HEARTBURN

A burning feeling behind the breastbone, often after eating or when lying down.

REGURGITATION

Food or sour, bitter fluid coming back towards the mouth.

DIFFICULT SWALLOWING

A sensation that food sticks or pain when swallowing.

CHEST DISCOMFORT

Pressure or pain behind the breastbone or in the upper abdomen that needs appropriate assessment.

EARLY FULLNESS

Bloating, belching, nausea or feeling full after a small meal.

COUGH OR HOARSENESS

Chronic cough, hoarseness or throat irritation, particularly at night.

Symptoms alone prove neither a hiatal hernia nor reflux. Depending on the case, endoscopy, imaging, pH monitoring or manometry may be needed.

ОПЕРАЦИИ

Hiatal-hernia procedures

Hiatal closure and the antireflux procedure are planned as one functional reconstruction.

01TYPE I

SLIDING HIATAL HERNIA REPAIR

Return of the gastro-oesophageal junction below the diaphragm and repair of the hiatus.

КОГДА РАССМАТРИВАЕТСЯ: Objectively confirmed reflux with persistent troublesome symptoms despite appropriate treatment or with complications, and selected large hiatal hernias.
ЧТО ВКЛЮЧАЕТ: Oesophageal mobilisation, reduction, crural closure and a selected antireflux procedure.

02TYPE II–IV

PARAOESOPHAGEAL HERNIA REPAIR

Reduction of the stomach and any organs displaced into the chest.

КОГДА РАССМАТРИВАЕТСЯ: Symptomatic large paraoesophageal hernia, obstruction, anaemia or concern for volvulus. A truly asymptomatic type II–IV hernia may be monitored after shared decision-making.
ЧТО ВКЛЮЧАЕТ: Sac dissection, restoration of intra-abdominal oesophagus and hiatal closure, with gastropexy or an antireflux procedure only when indicated.

03CRUROPLASTY

POSTERIOR CRUROPLASTY

The diaphragmatic crura are reapproximated around the oesophagus without excessive tension.

КОГДА РАССМАТРИВАЕТСЯ: An enlarged hiatus during surgical repair.
ЧТО ВКЛЮЧАЕТ: Calibrated posterior suture closure; mesh reinforcement is used selectively rather than routinely.

04360°

NISSEN FUNDOPLICATION

A 360° wrap around the lower oesophagus to reinforce the antireflux barrier.

КОГДА РАССМАТРИВАЕТСЯ: Selected reflux disease with suitable oesophageal motility.
ЧТО ВКЛЮЧАЕТ: A short, tension-free wrap after complete anatomical restoration.

05270°

TOUPET FUNDOPLICATION

A 270° posterior partial wrap balancing reflux control and swallowing.

КОГДА РАССМАТРИВАЕТСЯ: Selected patients in whom a partial wrap is preferred based on functional assessment.
ЧТО ВКЛЮЧАЕТ: The fundus is fixed posteriorly and to the sides of the oesophagus without a complete wrap.

06REDO

COMPLEX OR REDO HIATAL REPAIR

Specialist reconstruction for major recurrence or failure of a previous procedure.

КОГДА РАССМАТРИВАЕТСЯ: Recurrence, wrap migration, dysphagia or complex anatomy after previous surgery.
ЧТО ВКЛЮЧАЕТ: Adhesiolysis, careful definition of the altered anatomy and tailored reconstruction, with gastropexy or reinforcement where appropriate.

Оригинальная реалистичная анатомическая иллюстрация для обучения — не фотография пациента.

ПЛАНИРОВАНИЕ И БЕЗОПАСНОСТЬ

Functional assessment before the surgical decision

A hiatal hernia on a test is not by itself an indication for surgery. Symptoms must correlate with anatomy and function, while mesh or gastropexy is considered selectively.

ENDOSCOPY

Assessment of oesophagitis, stomach and anatomy.

FUNCTION

Manometry and 24-hour pH monitoring ± impedance when they affect management.

TENSION FREE

Adequate intra-abdominal oesophageal length and calibrated closure.

SWALLOWING

Wrap selection is tailored to function.

ВОПРОСЫ

ЧАСТЫЕ ВОПРОСЫ

Краткие ответы перед индивидуальной консультацией хирурга.

01Is a minimally invasive approach always possible?

No. It is chosen when safe and meaningfully beneficial. Anatomy, previous surgery and complexity may require another approach or conversion.

02How long does recovery take?

Recovery varies with the procedure, disease severity and general health. The individual plan covers mobilisation, diet, work and exercise.

03Will I stop reflux medication immediately?

Not necessarily. Postoperative medication and diet are individualised and reviewed during follow-up.

КЛИНИЧЕСКИЕ ДАННЫЕ

Окончательный выбор зависит от клинической картины, анатомии и актуальных рекомендаций.

01SAGES · Surgical Treatment of Hiatal HerniasOfficial clinical practice guidelineОФИЦИАЛЬНЫЙ ИСТОЧНИК 02SAGES · GERD Surgical TreatmentGuideline for surgical treatment of refluxОФИЦИАЛЬНЫЙ ИСТОЧНИК 03NHS · Hiatus HerniaSymptoms and when to seek medical assessmentОФИЦИАЛЬНЫЙ ИСТОЧНИК 04NIDDK · GER & GERD in AdultsSymptoms of gastro-oesophageal refluxОФИЦИАЛЬНЫЙ ИСТОЧНИК

Информация носит образовательный характер и не заменяет осмотр врача. Риски и альтернативы обсуждаются индивидуально.

ИНДИВИДУАЛЬНАЯ ХИРУРГИЧЕСКАЯ ОЦЕНКА

Правильная операция начинается с правильных показаний.

На консультации оцениваются симптомы, исследования и альтернативы.

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