A. A. Nurgudin

Introduction. A hiatal hernia (HH) is a condition of weakened diaphragmatic ligaments, resulting in stretching and enlargement of the hiatal opening and protrusion of abdominal organs into the pleural cavity. In the pathogenesis of HH, one of the leading roles is played by the structural degradation of connective tissue fibers of the esophageal-diaphragmatic membrane and weakening of the ligamentous apparatus of the stomach. A common method of HH surgical treatment involves laparoscopic Nissen fundoplication combined with anterior or posterior cruroraphy. An alternative method is the use of robot-assisted surgery. Materials and methods. During the period from April 2022 to January 2024, 113 robot-assisted laparoscopic fundoplications were performed in the thoracic surgery unit at the Hospital of Bashkir State Medical University (Ufa, Russian Federation). The patients were divided into two groups. A research group ( n = 65) underwent robot-assisted laparoscopic Nissen fundoplication with modified cruroraphy and cuff fixation with Z-shaped sutures according to patent 2813330C1. A control group ( n = 48) had standard laparoscopic Nissen fundoplication with anterior cruroraphy using interrupted sutures. The age of operated patients ranged from 35 to 65 years, including 72 and 28% of women and men, respectively. All surgical interventions were performed using the Da Vinci Si robotic system. Results and discussion. The use of an advanced technique (patent 2813330C1) in robot-assisted interventions for type III HHs prevents cuff migration and slippage, including into the pleural cavity, as well as the occurrence of the “telescope” symptom. It helps achieve symmetry and prevent cuff deformation and slippage, as well as ensures early patient activation and initiation of enteral nutrition through the use of laparoscopic techniques and Z-shaped suture with nonabsorbable suture material. Conclusion. The positive results of surgical interventions performed for type III HHs using the developed technique (patent 2813330C1) demonstrate the proposed method promising for videoendoscopic surgery.