Hiatal hernia surgery is performed to correct hiatal hernia in which symptoms are not relieved by medications and lifestyle modifications. Usually, patients stay in the hospital for a day or two after hiatal hernia surgery.
Being a major surgery, complete recovery can take 10 to 12 weeks. Most patients can resume their normal activities earlier than 10 to 12 weeks.
What is hiatal hernia?
When an organ protrudes through the muscle wall that surrounds it, it is called a hernia. The upper part of the stomach protrudes into the chest, pushing through the small opening (or hiatus) in the diaphragm, causing a hiatal hernia (which separates the abdomen from the chest).
Hiatal hernias are usually so tiny that they are not felt at all. However, if the hernia is a bit larger, it may cause the opening in the diaphragm to expand as well. The entire stomach and other organs are in danger of slipping up into the chest at that moment.
By compressing or twisting the stomach, a hiatal hernia can place unnecessary pressure on it. Because of the pressure, one may experience chest pain, gastroesophageal reflux disease (GERD), and heartburn, as well as difficulty swallowing or breathing. The acid can induce stomach ulcers, which can bleed and produce acute or chronic anemia (low blood counts).
Hiatal hernias come in a variety of shapes and sizes. Sliding Hiatal hernias or type I hernias are the smallest and most frequent. These hernias force the stomach to slide up into the chest through a small gap in the diaphragm. These do not always necessitate surgery or treatment.
Types II, III, and IV hernias, also called paraesophageal hernias, are much less prevalent. These are caused by a portion of the stomach protruding into the chest near the esophagus. That portion of the stomach gets "stuck" above the diaphragm and is unable to descend.
Though these hernias are significantly less common, they can be more harmful because they create more serious symptoms and can disrupt the stomach's blood flow.
What are the risk factors for hiatal hernia?
People aged 50 years and older, pregnant women, and those who are obese are at a higher risk. Intense pressure on the hiatus muscles can potentially cause a hiatal hernia.
Coughing, vomiting, extreme straining during bowel motions, moving large things, and severe physical exercise can contribute to high blood pressure.
What are the symptoms of hiatal hernia?
Hiatal hernias, particularly type I hernias, are frequently asymptomatic. They may, however, be linked to symptoms, such as burping, heartburn, nausea, vomiting, or esophageal regurgitation.
A paraesophageal hernia or type II, III, or IV hernia might result in more serious symptoms that include the following:
- Chest or abdominal pain
- Continual abdominal bleeding (which can be indicated by blood in vomit, red, or black stool, anemia, blood test indicating loss of blood)
- Early satiety causes a change in voice (or becoming full after eating a small amount of food)
- Occasionally having difficulty swallowing (especially solid food)
- After eating, you may experience shortness of breath or difficulty breathing
- Acid reflux
- Regurgitation or a feeling that food is "sticking" in the stomach
What are the types of hiatal hernia surgery?
A hiatal hernia can be treated with Nissen fundoplication (keyhole surgery), open repairs, or endoluminal fundoplication.
General anesthesia is required for all three procedures.
The most common surgery for a hiatal hernia is a Nissen fundoplication. Laparoscopic or keyhole surgery is used in this treatment. This operation is minimally invasive, requiring only a few small incisions in the abdomen by the surgeon.
- To repair the hernia, the surgeon inserts a laparoscope, which is a narrow tube with a light and a camera, into the abdomen.
- To prevent the hernia from returning, the surgeon may constrict the stomach entrance.
Compared to other methods of hiatal hernia surgery, laparoscopic repair has a few advantages, such as:
- Infection risk is reduced
- Scarring is minimized because it is less painful
- Recovery is usually quicker when you spend less time in the hospital
Open surgical options
In open surgery, the surgeon makes a bigger incision in the abdomen to repair the hernia. The risks of this surgery are more than a laparoscopic repair.
A surgeon will pull the stomach back into the abdominal cavity and wrap the fundus or upper portion around the lower portion of the esophagus. This tightens the sphincter, preventing stomach acid from spilling into the esophagus (reflux).
To maintain the stomach in place, the surgeon may need to implant a tube. After a few weeks, the doctor will remove the tube.
This method is relatively new and is even less invasive than laparoscopic repair. There are no incisions required by the surgeon. Instead, they insert an endoscope (a tube with a light and camera) into the food pipe and down the throat.
To avoid reflux, the surgeon tightens the region where the stomach and esophagus meet.
Most patients will not have much pain after laparoscopic surgery, but they may endure discomfort in their abdomen and chest, as well as difficulty swallowing. This normally goes away after 48 hours.
If the anesthetic has worn off, a person may be able to go home the same day after a laparoscopy. Otherwise, they may be admitted to the hospital for the night and should be able to walk the next day.
Health Solutions From Our Sponsors
Qureshi WA. Hiatal Hernia. Medscape. https://emedicine.medscape.com/article/178393-overview
Cleveland Clinic. Nissen Fundoplication. https://my.clevelandclinic.org/health/treatments/4200-nissen-fundoplication
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