Grubnyk V. Substantiation of the expediency of using meshes in laparoscopic surgical treatment of patients with large hiatal hernias

The "gold standard" of surgical treatment of patients with large hiatal hernias (HH) is laparoscopic fundoplication with crura repair. In the presence of large HH, a high risk of hernia recurrence is considered, the frequency of reccurence rate reaches up to 50%. To prevent the recurrence rate after surgery, mesh implants are used. A serious problem with synthetic mesh implants is the risk of severe postoperative complications such as scarring, strictures, erosion, and perforation of the esophagus. Thus, the question of the required size, material, and configuration of a mesh implant for its reliable and safe use remains debatable. In this work, the indications for the use of mesh implants in patients with large HH were determined by studying the biological properties of the esophageal-gastric junction and a clinical and experimental study of the tension force of the sutures of crura repair. The dissertation also presented the results of a study of a new alloplasty technique to improve the results of operations in patients with large HH and a comparison of different types of mesh implants. The introduction of research results into practice solves an important scientific issue - the expansion of knowledge about the mechanism of recurrence of HH and the possibility, using the developed algorithm, to choose the optimal method of surgical treatment of patients with large HH.