Hiatal hernia

Hiatal hernia is a pathological dilatation of esophageal opening of diaphragm, when ligaments, fixing esophagus and stomach, are expanded. As a result, the superior part of stomach finds itself in the thorasic cavity, and the work of the inferior esophageal sphincter is disturbed. A patient feels heartburn, especially at nights in the horizontal position, pain behind the sternum, dry coughing, problems with heart

If there are no effects due to medicamentous therapy, there is an indication to perform on operation, and the essence of it is restoration of normal anatomical correlation in the area of esophagus and stomach.

Esophagus and the superior part of stomach are exposed from adhesions and are brought down to the abdominal cavity up to the normal level. Then I perform on cruroraphy (decrease of the opening in diaphragm) and fundoplication (creation of the cuff to prevent reflux of contents of stomach into the esophagus).

The peculiarity of my technique is a careful performing on operation, restoration of anatomy of the superior floor of the abdominal cavity and creation of functional gastroesophageal valve, that will promote to have usual way of life for a patient, without taking tablets. When I expose esophagus and stomach, I use the contemporary apparatus of dosed electrothermal ligation of tissues “LigaSure” (U.S.A.), that gives a possibility to “weld” vessels without injuring the surrounding structures. The use of contemporary synthetic absorbable thread and anticommissural barriers also improve the results of my operations. Fundoplication according to Toupe (France, 1984) implies that the abdominal part of esophagus is turned round by stomach, and it is 270 degrees- it gives me a possibility to guarantee my patients physiological work of sphincter after operation.

I have modified fundoplication according to Toupe, where 270 degrees are used, not 360 degrees as compared to fundoplication according to Nissen, when an absolute valve is formed, that does not exist in nature at all. My modified technique is without disadvantages. I constantly mention that fundoplication according to Nissen is harmful. And many prominent gastroenterologists of our country agree with me.

If you want to make an appointment with the doctor,

please, call the tel: +7 495 222-10-87 +7 903 798-93-08 Olga - that is my assistant.

Or you may use my e-address: puchkovkv@mail.ru puchkovkv@mail.ru copy

«When you write me letters, you should be sure that all of them will find themselves in my e-mail. I always reply your letters myself. I remember that you trust me the most precious things - your health, your fate, your family, your nearest and dearest, and I always try to do my best to justify your trust.

Every day I answer your letters, and it takes me several hours.

When you write me letters, you can be sure, that I will learn your situation very attentively, in case of need I will ask for some additional medical documents.

A great clinical experience and thousands of successful operations will give me a possibility to understand your problem even at some distance. Many patients need not surgical treatment, but properly administered conservative treatment, but some patients need urgent surgery. In both cases I would recommend additional investigations in case of need or admitting to hospital. It is important to bear in mind that some patients need preliminary treatment of accompanying diseases in order to have a successful operation.

In your letter, please, mention your age, main complaints, your place of residence, telephone number and e-mail.

For me to be able to give you a full answer, please, forward me a scanned conclusion of USI, CT, MRT alongside with your question, as well as conclusions of other specialists. After studying your case I will forward you either my detailed reply, or a letter with some additional questions to clarify the situation. Anyhow, I will try to help you and justify your hope and trust that are the most important things for me.

Sincerely, your

surgeon Konstantin Puchkov»