Hiatal Hernia Surgery

A hiatal or diaphragmatic hernia occurs when the lower part of the esophagus and a portion of the stomach slide up through the esophageal hiatus, an opening in the diaphragm through which the esophagus passes before it reaches the stomach. In few cases, the junction of the esophagus and stomach remains in place, but a portion of the stomach rolls up and through the esophageal hiatus alongside the esophagus.

 

Hiatal hernias are repaired using a procedure known as Nissen fundoplication, which is surgery to repair a bulging (herniation) of stomach tissue through the muscle between the abdomen and chest (diaphragm) into the chest (hiatal hernia).

 

When the hiatusis too large some of the stomach can slip up into the chest cavity. This can cause heartburn (gastro-esophageal reflux) as gastric acid backflows from the stomach into the esophagus. Gastro-esophageal reflux can, over many years, damage the mucosa of the esophagus and or may even cause cancer of the esophagus.

 

This procedure may be performed laparoscopically. In a laparoscopic fundoplication, small (1 cm) incisions are made in the abdomen, through which instruments and a fiberoptic camera are passed. The operation is performed using these small instruments while the surgeon watches the image on a video monitor. Laparoscopic fundoplication results in less pain and shorter hospitalization times than the open operation.

Patient is given general anesthesia and during the surgery, the stomach and lower esophagus are placed back into the abdominal cavity. The opening in the diaphragm (hiatus) is tightened and the stomach is stitched in position to prevent reflux. The upper part of the stomach (fundus) may be wrapped around the esophagus (fundoplication) to reduce reflux.

 

Patients may need to spend 3 to 10 days in the hospital after surgery.

 

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