Malynovskyy A. Laparoscopic repair of large and giant hiatal hernias

The aim of dissertation is to decrease the rate of recurrences and complications following laparoscopic procedures for large and giant hiatal hernias by means of new approach and new methods of repair. Long-term results of treatment of 899 patients with hiatal hernias were analysed. Based on retrospective study, an applied classification of hiatal hernias, grounded on hiatal surface area, was created: small hernias (with hiatal surface area less than 10 cm2), large hernias (with hiatal surface area of 10 - 20 cm2), and giant hernias (with hiatal surface area more than 20 cm2). Primary crural repair was proved to be a procedure of choice for small hernias. A prospective randomized study proved that original technique of double-layer repair with partially absorbable lightweight mesh is a procedure of choice for large hernias. A new method of tension-free frame repair with lightweight polytetrafluoroethylene mesh with peripheral nitinol frame was created. This method first demonstrated absence of recurrences and complications of giant hiatal hernias. Prospective cohort and randomized studies proved that tension-free frame repair is a procedure of choice for giant hiatal hernias.