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The most common is the Nissen operation, which proposed a 360° fundoplication for the treatment of esophageal hernia complicated by esophagitis.

It consists in the formation of a circular cuff from the anterior and posterior walls of the fundus of the stomach, enveloping the mobilized abdominal esophagus, in which the 30-32F1 probe is installed. The edges of the stomach are sutured together with the wall of the esophagus. The width of the cuff is at least 2.5-3 cm. With a wide hernial opening (more than 3.5 cm), the legs of the diaphragm are sutured together behind or in front of the esophagus (posterior or anterior crurorrhaphy) to the normal size of the POD.

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With a POD diameter of more than 5 cm, it is advisable to strengthen the crororaphy with a mesh prosthesis made of non-absorbable synthetic material to prevent recurrence of a hernia. The Nissen-Rossetti fundoplication also involves a 360° fundoplication with the difference that the gastric cuff is not fixed to the diaphragm (prevention of hiccups and pain during respiratory movements), but 1-2 sutures are placed between the esophagus and the gastric cuff on the side opposite from the sutures of lamotrigine pills (prevention of the expansion of the cuff in the fundic part of the stomach).

The disadvantage of the Nissen and Nissen-Rosetti operations is the twisting of the esophagus along the axis when the fundus of the stomach is passed under it. This can be avoided by the modification of the Nissen operation, in which the first short arteries of the stomach, the posterior (not covered by the peritoneum) wall of the cardia are mobilized, and the anterior and posterior walls of the gastric fundus are involved in the creation of the cuff. Toupet fundoplication consists in the formation of a symmetrical cuff from the anterior and posterior walls of the fundus of the stomach, enveloping the esophagus at 240-270°, leaving its anterior right surface free (localization of the left vagus nerve).

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Applied with small sizes of the fundus of the stomach. Many authors prefer this method of fundoplication due to buy lamotrigine online number of dysphagia in the early postoperative period (compared to the Nissen operation). This advantage is leveled in the future due to the greater number of relapses of reflux disease. Fundoplication according to Dor. It also involves partial fundoplication, while the anterior wall of the fundus of the stomach is placed in front of the abdominal esophagus, fixing it to the right wall of the esophagus.

This operation is ineffective, it is rarely used as a necessary measure when it is impossible to fully mobilize the esophageal-gastric junction and perform other types of fundoplication. Operation Cuschieri (1991) - creation of an acute angle of His using a round ligament of the liver, which, after partial mobilization from the navel, is carried out with a free end under the abdominal segment of the esophagus, pulling it to the right and anteriorly (an acute angle of His is formed). Rarely used due to low efficiency.

With hernias, combined with a pronounced shortening of lamictal pills (congenital or due to esophagitis), the best results are obtained by the Colli operation.s-nissen. The operation consists in lengthening the abdominal esophagus due to the lesser curvature of the stomach, followed by gastrofundorrhaphy (enveloping the newly created esophageal tube from the lesser curvature of the esophagus with the walls of the fundus of the stomach according to the Nissen fundoplication type).

Hernia operations themselves can be performed in university clinics, private medical centers, public hospitals.

Prices are announced to patients after a consultation with a doctor. The final amount is affected by the degree of the disease, the type of hernia, the presence of complications and many other factors. In Usa, for example, the price for one operation varies between 18,000 and 135,000 usd. In children, a hernia is removed in institutions where there are pediatric surgeons.