A hiatal hernia occurs when part of the stomach moves upwards into the chest. If the hernia causes severe symptoms or is likely to cause complications, then hiatal hernia surgery may be required.
Not everyone who has a hiatal hernia will require surgery. Many people will be able to treat the condition with medication or lifestyle changes. However, for those who do need surgery, there is a range of procedures available, the most common being Nissen fundoplication.
This article discusses hiatal hernia surgery procedures, expected recovery times. complications, and risks.
Most Hiatal hernias do not cause symptoms, and therefore treatment is not usually necessary. Those who have mild symptoms, such as heartburn, acid reflux, or gastroesophageal reflux disorder (GERD) may be able to treat their condition with medications or lifestyle changes.
However, surgery may be recommended if:
There are three types of surgery for a hiatal hernia: Nissen fundoplication (keyhole surgery), open repairs, and endoluminal fundoplication. All three procedures require a general anesthetic.
A Nissen fundoplication is the most commonly performed surgery for a hiatal hernia. This procedure uses laparoscopic repair or keyhole surgery. This surgery is minimally invasive and only requires the surgeon to make a few tiny incisions in the abdomen.
The surgeon inserts a laparoscope, which is a thin tube with a light and a camera, into the abdomen to repair the hernia. The surgeon may also tighten the stomach opening to prevent the hernia from coming back.
Laparoscopic repair has some advantages over other types of hiatal hernia surgery. These include:
Open surgery involves making a larger incision in the abdomen so that the surgeon can fix the hernia. This procedure carries more risks than laparoscopic repair.
A surgeon will pull the stomach back up into the abdominal cavity and wrap the upper portion, called the fundus, around the lower part of the food pipe. This creates a tight sphincter which stops the stomach acid from leaking up into the food pipe (reflux).
Sometimes, the surgeon may need to insert a tube to keep the stomach in place. The doctor will remove the tube after several weeks.
This procedure is relatively new and is even less invasive than laparoscopic repair, though it is not commonly used. The surgeon does not need to make any incisions. Instead, they place an endoscope (a tube with a light and camera) down the throat and into the food pipe.
The surgeon tightens the area where the stomach and esophagus join to prevent reflux.
However, this treatment may have its limitations. According to an interview published in the journal Gastroenterology and Hepatology in 2015, the endoluminal devices developed to date are not entirely reliable, and many people experience their symptoms coming back.
After laparoscopic surgery, most people will not experience much pain, but they may feel discomfort in their abdomen and chest and have difficulty swallowing. This usually passes within 48 hours.
After a laparoscopy, a person may be able to go home the same day if they have recovered from the anesthetic. Otherwise, they may spend a night in the hospital and should be able to walk around the day after the surgery.
A person may soon feel well again but may find that they tire easily.
In the days after surgery, a person will usually be advised to:
In the weeks after surgery, the UK National Health Service (NHS) recommend the following:
A person will need to follow a specific diet after surgery. It is advisable to drink clear liquids immediately after surgery and move onto soft or liquefied foods, including mashed potatoes, smoothies, and soups, the following day. A person should also avoid foods that cause gas and bloating.
During recovery, it might be a good idea for people to eat several smaller meals throughout the day instead of three large ones.
Most people can return to their regular diet between 3 to 6 weeks after surgery.
However, even after a person makes a full recovery, their doctor may recommend they continue to limit or avoid foods that contribute to gas, bloating, and acid reflux symptoms, such as:
Open surgery will usually require a lengthier stay in the hospital and an extended recovery time.
Nissen fundoplication is very effective for relieving symptoms of GERD. A 2009 studyTrusted Source estimates that this surgery achieves a success rate of 90 to 95 percent.
The same study also suggests that even when the laparoscopic surgery has to be carried out again to control reflux symptoms further, the success rate is 86 percent.
The NHS in the UK estimate that 80 to 85 percent of people will continue to have relief from symptoms 10 years after surgery.
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