laparoscopic hiatal hernia repair surgery in Bangalore
June 7, 2021Dr Vamsi Krishna
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:
symptoms are severe and interfere with quality of life
symptoms do not respond to other treatments
the hernia is at risk of becoming strangulated, which is where the blood supply to the herniated tissue is cut off — a situation that can be fatal
symptoms include bleeding, ulcers, or narrowing of the food pipe (esophagus), which is known as an esophageal stricture
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:
less risk of infection
less time in the hospital
recovery is usually quicker
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:
wash the incision area daily with plain soap and water
shower instead of bathing, and avoid the use of pools and hot tubs
walk about when possible to stop blood clots from forming in the leg
avoid drinking through a straw
practice specific breathing and coughing exercises to strengthen the diaphragm
returning to work within 2 to 3 weeks, or whenever a person is feeling well enough
taking painkillers for several days after surgery to minimize discomfort
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:
acidic foods, including citrus fruits and tomato products
beans and lentils
cruciferous vegetables, including broccoli, cabbage, and cauliflower
Open surgery will usually require a lengthier stay in the hospital and an extended recovery time.