Laparoscopic Hiatus Hernia

What is Hiatal Hernia?

The portion that connects the stomach and esophagus pushes up through an opening in the diaphragm (chest region). However, in the paraesophageal Hiatal Hernia, a part of the stomach pushes up through the diaphragm on its own from the connecting portion. This is the most commonest form of Hernia. The patients that have a hiatal hernia have an enlarged opening. The Lower Esophageal Sphincter (LES) which is usually the high pressure zone near the junction of the stomach and esophagus, fails and allows stomach contents to reflux into the esophagus

Symptoms:

The major symptoms that most of the patients experience are:

  • Regurgitation – which can worsen while lying flat
  • Acid reflux
  • Asthama
  • Pain with swallowing
  • Chest Pain
  • Stomach twisting and perforation

Diagnosis:

  • Chest X-Ray – That measures Air Fluid Level in the chest
  • Esophagram – That assesses the function of the esophagus and identifies structural abnormalities like twisting of the stomach. It also reveals associated problems (e.g. aspiration, poor gastric emptying)
  • Upper Endoscopy: It identifies damage that is caused by reflux such as Esophagitis, Malignancy etc.
  • Manometry: It assesses the function of Lower Esophageal Sphincter (LES) and also assesses the wave-like motion of the esophagus.

Procedure

The symptoms can be usually managed successfully with proper guided medications. However in a few cases patients may have to undergo surgical intervention.

The treating doctor shall make several very tiny incisions in the abdomen and inserts the laparoscopic instruments to perform the procedure. The procedure gently pushes the stomach/other organs back into the place through a diaphragmatic opening called hiatus and it repairs and tightly closes the opening to prevent future herniation. A special surgical mesh is used to stitch the hiatus. A feeding tube may be placed in the stomach that exists through the skin of the abdomen in order to prevent the stomach from displacing upwards during healing, or the stomach may be sutured to the connective tissue in the abdomen.

This procedure helps to reinforce the position and function of LES and helps address symptoms of reflux. It is a minimal invasive procedure and results in very less pain, quick recovery and faster healing.

Post Procedure

  • Approximately 1-2 days stay in the hospital is advised post surgery.
  • Most patients can resume their normal duties and activities within a weeks time and may completely recover within 2-3 weeks.
  • Heavy physical activities or exertion should be avoided for a few months.

Advantages of Hiatal Hernia

  • Minimal invasive procedure hence less pain from the incisions
  • Better healing, cosmetically as well as physically
  • Resuming to routine work and normal activities is faster
  • Recovery time is shorter
  • Less Hospital stay of around 24-48 hours only
  • Less risk of infection