Personalizes approach to selecting revision antireflux surger

Introduction. Recurrences of hiatal hernias and gastroesophageal reflux disease (GERD) following primary surgical treatment remain a challenging problem in abdominal surgery. Failure rates reach 15–60 %, with key manifestations including recurrent reflux, dysphagia, and gas–bloat syndrome. The causes of recurrence are multifactorial: fundoplication wrap migration, cicatricial strictures, diaphragmatic weakness, and technical errors from the initial procedure. The purpose of the study. To analyze existing fundoplication techniques and develop personalized approaches to reoperative antireflux surgery. This strategy is based on comprehensive preoperative diagnostics, analysis of primary surgery failure causes, and selection of optimal corrective methods (fundoplication type, mesh reinforcement necessity, esophageal mobilization). Materials and methods of research. Review of articles published in scientific databases such as PubMed, Web of Science, Scopus, and eLIBRARY. Results of research. Performing comprehensive multimodal diagnostics enables identification of the causes of recurrent hiatal hernia and GERD. For large defects, the use of a U–shaped synthetic mesh is justified. For esophageal shortening less than 1 cm, Collis gastroplasty is indicated; for shortening exceeding 1–2 cm, Chernousov's technique is applied. A complete fundoplication is applicable in cases of severe reflux with normal motility, a partial fundoplication is used for significant dysphagia and hypomotility, and an anterior fundoplication is indicated in the presence of cicatricial fibrosis or as an adjunct to cardiomyotomy for achalasia. Conclusion. Revisional surgery requires strictly individualized management. Success depends on: precise diagnostics, appropriate technique selection (combined cruroplasty, mesh repair, fundoplication), anatomical defect correction, surgical expertise, and adherence to rehabilitation protocols – minimizing recurrences in complex cases.