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Hiatus Hernia

What is Hiatus Hernia?

It’s the protrusion (or herniation) of the upper part of the stomach into the thorax, through a weakness in the diaphragm opening for the oesophagus.

Varies from a small portion of the stomach sliding up through a small weakness in the diaphragm to a large defect with most of the stomach and occasionally other organs like the colon and spleen pushing into the chest.

hiatus hernia diagram showing normal and affected.

Why Is The Hiatal Hernia Repair Surgical Procedure Performed?

Gastro-oesophageal reflux disease (GORD) is initially treated with lifestyle changes, including a weight loss plan, reducing or eliminating smoking and alcohol consumption and altering eating patterns. If symptoms persist after these lifestyle changes are commenced, then drug therapy (to help in neutralizing or decreasing the gastric acid production) is initiated.

Surgical therapy should be considered, when patients:

  • Have failed medical management (inadequate symptom control, severe regurgitation not controlled with acid suppression)
  • Some patients opt for a surgery, despite successful medical management to avoid taking medication or if they develop side effects to the medications
  • Due to complications of GORD, including erosive oesophagitis, stricture, and/or Barrett’s oesophagus (condition where the inner lining of the oesophagus changes to that of the stomach lining, due to acid irritation)
  • Have extra-oesophageal manifestations, such as asthma, hoarseness, cough, chest pain, and/or aspiration

How Is The Hiatal Hernia Repair Surgical Procedure Performed?

The surgical procedure used is called Hiatal Hernia Repair with Fundoplication.

  • In this procedure, the lower end of the oesophagus and the upper part of the stomach is freed completely
  • The hernia is reduced bringing the gastro-oesophageal junction below the diaphragm
  • Then the opening on the diaphragm is narrowed. This narrowing is performed with sutures, and is called a diaphragmatic crural repair or cruroplasty
  • To prevent recurrence of the hiatal hernia and reflux of gastric acid, the gastric fundus (upper part of the stomach) is wrapped around the lower part of the oesophagus
  • The procedure can be performed via open or laparoscopic approach, through the abdomen or through the chest
  • Large diaphragm defects and presence of weak tissue may require placement of synthetic or biological mesh
  • With proper patient selection, laparoscopic fundoplication has low complication rates and a quick recovery

nissen fundoplication surgery

A Hiatal Hernia Repair With Mesh

hiatal hernia repair with mesh

Risks

Risks or complications following fundoplication surgery include but not limited to:

  • Difficulty swallowing because the stomach is wrapped too high on the oesophagus or is wrapped too tightly
  • Heartburn that comes back
  • Bloating and discomfort from gas build up because the person is not able to burp
  • Excess gas or flatulence
  • Oesophagus or stomach injury requiring repeat surgery or prolonged hospitalisation
  • Mesh infection or erosion
  • Recurrence of the hernia

Advance Surgical Perth

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