COMPLICATIONS AND RESULTS OF SURGICAL TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE

Recently gastroesophageal reflux disease (GERD) was associated only with reflux-esophagitis and appeared to be a harmless disease with the most frequently noted symptom - heartburn. However, prolonged gastroesophageal reflux often provokes attacks of bronchial asthma, ischemic heart disease, is the cause of severe caries, repeated pneumonia and even cancer of the larynx. Terrible complications of GERD are ulcers of the esophagus with blood loss of various degrees, as well as stricture of the esophagus. It is with the widespread prevalence of GERD and its complications (in particular, Barrett's esophagus) that some authors associate an increase in the incidence of adenocarcinoma of the distal esophagus (up to 50 %) among all cases of esophageal cancer. In addition, according to some authors, GERD contributes to the occurrence of laryngeal cancer. Previously, GERD was understood as peptic or terminal esophagitis, but it is known that in more than 50 % of patients with reflux symptoms there is no visible lesion of the esophageal mucosa. It was found that with duodeno-gastral reflux, against a background of decreased acid formation in combination with anthropyloroduodenal dyskinesia, the alkaline contents of the duodenum affect the mucosa of the esophagus. Inflammatory-destructive changes in the mucous membrane of the esophagus may be more pronounced than caused by acid aggression. An important clinical fact is their resistance to conventional therapy. Part of patients with GERD have expressed motor disorders of the esophagus. Obviously, the existing motor disorders lead to the development of GERD, and subsequently, as a result of the direct effect of the inflammatory process on the nerve plexuses in the wall of the esophagus, motor dysfunction is aggravated.

GERD, laparoscopic esophagofundoplication, gastroesophageal hernia

1. Галимов О.В., Ханов В.О., Гаптракипов Э.Х. Новые технологии в хирургическом лечении гастроэзофагеальной рефлюксной болезни // Хирургия. -2007. - № 2.- С. 29-33. Galimov OV, Khanov VO, Gaptrakipov EK. (2007). New technologies in surgical treatment of gastroesophageal reflux disease [Novye tekhnologii v khirurgicheskom lech-enii gastroezofageal’noy reflyuksnoy bolezni]. Khirurgiya, (2), 29-33.

2. Пучков К.В., Филимонов К.В. Грыжи пищеводного отверстия диафрагмы. - М.: Медицина, 2003. - 172 с. Puchkov KV, Filimonov KV. (2003). Hiatal hernias [Gry-zhipishchevodnogo otverstiya diafragmy]. Moskva, 172 p.

3. Трухманов А.С. Гастроэзофагеальная рефлюксная болезнь: клиника, диагностика, лечение // Библиотека МРЖ. Болезни органов пищеварения. - 2001. - Т. 3, № 1. - С. 19-24. Trukhmanov AS. (2001). Gastroesophageal reflux disease: clinical findings, diagnostics, treatment [Gastroez-ofageal’naya reflyuksnaya bolezn’: klinika, diagnostika, lechenie]. Biblioteka MRZh. Bolezni organov pishcheva-reniya, 3 (1), 19-24.

4. Чернов В.П., Хитарьян А.Г. Грыжи пищеводного отверстия диафрагмы. Эпидемиология, патогенез, клиника, диагностика и лечение. - Р-на-Дону, 2000. - 189 с. Chernov VP, Khitaryan AG. (2000). Hiatal hernias. Epidemiology, pathogenesis, clinical findings, diagnostics, and treatment. [Gryzhi pishchevodnogo otverstiya diafragmy. Epidemiologiya, patogenez, klinika, diagnostika ilechenie]. Rostov-na-Donu, 189 p.

5. Allgood P.C., Bachmann М. (2000). Medical or surgical treatment for chronic gastro-oesophageal reflux? A systematic review of published evidence of effectiveness. Eur J Surg, 166, 713-721.

6. Anvari M. (2003). Five-year comprehensive outcomes evaluation in 181 patients after laparoscopic Nissen fundoplication. J Am Coll Surg, 196, 51-57.

7. Lundell L., Abranamsson H., Ruth M.M. (1996). Longterm results of a prospective randomized comparison of total fundie wrap (Nissen - Rossetti) or semifundoplication (Toupet) for gastroesophageal retlux. Br J Surg, 83, 830-835.

8. Nissen R. (1961). Gastropexy and fundoplication in surgical treatment of hiatus hernia. Am J Dig Dis, 6, 954-956.

9. Rossetti M., Hell K. (1977). Fundoplication for treatment of gastroesoesoophageal retlux in hiatal hernia. World J Surg, 1, 439-443.