Anti-reflux surgical treatment for Barrett’s oesophagus

Authors

DOI:

https://doi.org/10.14739/2310-1210.2022.1.229215

Keywords:

hiatal hernia, Barrett’s esophagus, argon plasma coagulation, laparoscopy, fundoplication, crurophia

Abstract

The aim of the study. To improve the effectiveness of surgical treatment for patients with hiatal hernia (HH) and gastro-esophageal reflux disease (GERD) in combination with Barrett’s esophagus by developing a new method for surgical correction of the physiological cardia incompetence.

Materials and methods. The study was conducted in the Department of Digestive Surgery of the State Institution “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine” in 2020–2021 and involved 56 patients with HH and GERD, among them axial HH was detected in 42 patients (75.0 %) – type I; paraesophageal HH – in 6 patients (10.7 %) – type II; mixed HH – in 8 patients (14.3 %) – type III (code ICD-10 – K44). The diagnosis was established using esophagogastroduodenoscopy (by high-resolution NBI mode), X-ray and histological examinations, manometry.

Results. When the diagnosis of HH in combination with Barrett’s esophagus was confirmed, a two-stage treatment was performed. During the first stage, argonoplasmic coagulation of the altered esophageal mucosa was done. Anti-reflux procedures constituted the second stage to remove HH and restore an excessive dilatation of the esophageal orifice of the diaphragm by cruroraphy with correction of anti-reflux function of the cardia by fundoplication, angle of His reconstruction and providing free food passage. 11 (19.6 %) patients underwent surgery according to a new technique that provided reliable recovery of cardia physiological functions and preservation of the anatomical relation between the diaphragm and the esophageal-gastric junction and included cruroraphy and fundoplication.

Conclusions. Thus, the proposed two-stage method of surgical treatment for patients with HH and GERD in combination with Barrett’s esophagus is highly effective. The application of the proposed method provides the elimination of pathological changes which are visible on conventional endoscopy in the esophageal mucosa, reliable restoration of cardia physiology and preservation of the anatomical relation between the diaphragm and the esophageal-gastric junction. In the post-surgical period, the proposed method of surgical treatment reduces the likelihood of recurrent failure of cardia physiological functions, dysphagia and Barrett’s esophagus.

 

Author Biographies

B. F. Shevchenko, SI “Institute of Gastroenterology of the NAMS of Ukraine”, Dnipro

MD, PhD, DSc, Professor, Senior Researcher of the Department of Surgery of Digestive Organs

N. V. Prolom, SI “Institute of Gastroenterology of the NAMS of Ukraine”, Dnipro

MD, PhD, Head the Department of Minimally Invasive Endoscopic Interventions and Instrumental Diagnostics, Senior Researcher of the Department of Surgery of Digestive Organs

O. M. Babii, SI “Institute of Gastroenterology of the NAMS of Ukraine”, Dnipro

MD, PhD, DSc, Head of the Department of Surgery of Digestive Organs, Senior Researcher

S. O. Tarabarov, SI “Institute of Gastroenterology of the NAMS of Ukraine”, Dnipro

MD, PhD, Endoscopist of the Department of Minimally Invasive Endoscopic Interventions and Instrumental Diagnostics

O. V. Zeleniuk, SI “Institute of Gastroenterology of the NAMS of Ukraine”, Dnipro

MD, PhD, Head of the Department of Surgery of Digestive Organs

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Published

2022-01-26

How to Cite

1.
Shevchenko BF, Prolom NV, Babii OM, Tarabarov SO, Zeleniuk OV. Anti-reflux surgical treatment for Barrett’s oesophagus. Zaporozhye Medical Journal [Internet]. 2022Jan.26 [cited 2024Nov.13];24(1):30-7. Available from: http://zmj.zsmu.edu.ua/article/view/229215

Issue

Vol. 24 No. 1 (2022)

Section

Original research

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