The emergence of modern high performance products for the treatment of gastroesophageal reflux disease as the main manifestation of hiatal hernias of esophagus (HH), trauma of antireflux operations performed in laparotomic access, led to a sharp reduction in the indications for surgical treatment of this pathology. Currently, laparoscopic procedures are routine surgical treatment of patients with gastroesophageal reflux disease (GERD) [5,7-13]. Despite the fact that, according to most surgeons, the "gold standard" in antireflux surgery is the Nissen fundoplication [5,11-13], the search for optimal intervention continues. They are based on a desire to minimize the effects of neblagopryatnye operations, the most serious of which is dysphagia, the frequency of which, according to various sources, ranging from 6 to 42% of cases [7,9,13-15] that the number of patients required reoperation . In this regard, remains an urgent problem of searching for minimally invasive surgery, safely reducing antireflux function of the cardia, on the one hand, and on the other - in the least degree affecting the propulsive ability of the esophagus.
Many authors agree that the study of quality of brand viagra online life of patients with a nosology of disease, treatment of which use different surgical techniques, can develop the best treatment strategy. At the present time has become a real and necessary opportunity to reliably determine the benefits of a treatment based on the qualitative characteristics of its results, such as changing the patient's well-being, a sense of satisfaction with life in the psycho-emotional and social aspects at the interface of the scientific approach, surgeons and the patient's subjective point of view [ 1,4].
The purpose of the study - the study of functional outcomes and quality of life of patients with GERD before and after the method developed in the clinic antireflux laparoscopic surgery.
Materials and methods
The basis for the clinical analysis and evaluation were 132 patients with GERD, who were on the examination and generic viagra treatment from 1999 to 2005. the Research Institute of Gastroenterology SSMU Seversk.
All 132 patients underwent surgery using a minimally invasive laparoscopic technology. Of these, 18 (13,6%) patients underwent laparoscopic fundoplication Toupet, 114 (86,4%) patients - laparoscopic fundoplication with the formation of an artificial lower esophageal sphincter (INPS) thread of an alloy of nickel titanium. Most patients (84.6%) were the most active age - between 21 and 60 years.
GERD combined with peptic ulcer disease in 26 (19,6%) patients with chronic calculous cholecystitis - in 22 (16.6%) patients with chronic calculous cholecystitis and duodenal ulcer - in 3 (2.2%) patients, with chronic calculous cholecystitis and diverticulitis of the duodenum - in 2 (1.5%) patients.
Indications for surgery were paraesophageal HH (n = 4) and complicated forms of HH (peptic ulcer of the esophagus, Barrett's metaplasia, chronic esophageal bleeding, and as a result, iron deficiency anemia (n = 36). 48 patients were diagnosed with HH in combination with chronic calculous cholecystitis (n = 22) and peptic ulcer disease (n = 26), and all patients a marked syndrome, gastro-esophageal regurgitation. ineffectiveness of conservative treatment for 8 weeks, the resumption of GERD symptoms immediately after the completion of the course of conservative therapy have led to the surgical treatment of 42 patients vnepischevodnye manifestations of GERD (asthma) - 2.
As soon as possible after surgery for complex survey specifically examined the symptoms of recovery antireflux function of brand name levitra esophageal-gastric junction (PZHP), the preservation of propulsive function of the esophagus, its permeability, the motor-evacuation function of the gastroduodenal complex. In the late postoperative period special emphasis on identifying signs of relapse of symptoms of deficiency zamykatelnoy function of the cardia, the functional state of artificial antireflux mechanism, dynamics of motor-evacuation function of the stomach.
All patients with GERD prior to surgical treatment, in terms of 1,5, 6 months, from 1 to 5 years after surgery with the formation of INPS determined by the quality of life through a specialized questionnaire GIQLI, comprising 36 questions. All questions are divided into 5 categories: perception of their health, mental health, physical generic levitra condition, social and role functioning. The maximum amount of points earned by the respondent, called gastrointestinal index (GII), and he is 144 points. In the control group (healthy respondents, n = 25), GII was 136 points. The distribution of scores by category in the control group, the following: perception of their health - 72.3 points, mental state - 18,5, physical state - 25.6, social functioning - 15.6, and role functioning - 4,0.
In the diagnosis of diseases using both clinical and instrumental methods. Study of the motor-evacuation function of the esophageal-gastric junction gastroduodenal complex was performed using polipozitsionnogo radiographic examination, transabdominal ultrasonography in the unit "Aloka SSD-2000 Convex sensors 3,5 and 5 MHz, stationary manometry, to enable a oesophageal manometry, antroduodenalnuyu manometry and electrogastrography (Multi-channel Poligraf ID using a water-perfusion catheter 9012R2271 Y1722 and processing of data using analysis software Polygram 1998 EM). Endoscopic examinations were performed fibrogastroskopami GiF R-30, GiF Q-40 company "Olympus" and the FG 29 V firm "Pentax" (Japan). Endoscopic ultrasono-graphs (EUS) of upper gastrointestinal tract was performed using a miniature ultrasound radial scanning probes UM-2R / UM-3R with a scanning frequency 12/20 MHz block the generation and processing of sound EU-M30, which were implemented through working channel videogastroskopa GIF-1T140 video EVIS EXERA GLV-160 companies, "Olympus" (Japan).
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