Current issues of surgical treatment of large and giant hiatal hernias

This work analyzes Russian and international literature sources that discuss the surgical intervention results for large and giant hiatal hernias. To date, there is no uniform classification of hiatal hernias by the size of the hernial defect. The classifications and algorithms for choosing the plastic method proposed by various authors provide no convincing evidence base. Although there are many methods for surgically correcting hiatal hernia, clear indications for their implementation have not been developed. The postoperative complications and relapses of the disease after surgery represent an unresolved issue. The laparoscopic approach for large and giant hiatal hernias is preferable to open surgery. However, it can lead to serious intra- and postoperative complications, especially in emergency cases. Alloplasty provides clinical improvement and an increase in the quality of life of patients, but has a relatively high risk of recurrence. To date, the treatment of hiatal hernias involves using various prosthetic materials, and their advantages and disadvantages are described in this article. Thus, the search for optimal surgical techniques to treat large and giant hiatal hernias continues.