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Hiatal Hernia Repair: The procedure, risks, complications, preparations and more

  • Posted on- Jul 13, 2016
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A hiatus hernia or hiatal hernia is the protrusion (or herniation) of the upper part of the stomach into the thorax, through a tear or weakness in the diaphragm. Hiatal Hernia Repair is a procedure indicated for the treatment of objectively documented, relatively severe, gastroesophageal reflux disease (GERD). This surgical procedure, also known as Anti-Reflux Surgery, is a consideration in chronic, long-term management of GERD.

What are the reasons behind a hiatus hernia surgical procedure?

  • Gastroesophageal reflux disease (GERD) is initially treated with lifestyle changes, including a weight loss plan, reducing or eliminating smoking and alcohol consumption, altering one’s eating and sleeping patterns, etc.
  • 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 a diagnosis of reflux, acid or non-acid (or bile reflux), is objectively confirmed

How a hiatus hernia surgical procedure is performed?

The surgical procedure used is called Hiatal Hernia Repair with Fundoplication. Generally, Nissen Fundoplication is the most common type of fundoplication performed. However, nowadays, laparoscopic approach is the commonly performed surgical treatment for this condition.
  • With proper patient selection, laparoscopic fundoplication has low complication rates and a quick recovery
  • Outcomes of the laparoscopic technique are best, when surgery is performed by a surgeon with experience using this procedure
  • Using a narrow tube-like instrument (cannula), the surgeon enters the abdomen in the area of the belly button
  • A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient's internal organs on a television screen
  • Other cannulas are inserted, which allow the surgeon to perform the surgical procedure
  • After completion of the repair and fundoplication, the small incisions are closed with stitches, or using surgical tapes

The hiatal hernia repair procedure is performed by a surgeon trained in general surgery, with assistance from an anaesthesiologist The time for repair of hiatal hernia procedure may take anywhere between 2-4 hours.

Preparations needed before a hiatus hernia surgical procedure

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine, if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Normally local anaesthesia is not used however, do inform the physician, if you are allergic to any local anaesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure 
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range if not their diabetologist may have to control blood sugar by recommending insulin or a combination of oral medicines

Diagnostic lab tests needed before a hiatus hernia surgical procedure

  • Upper gastrointestinal series with gastrograffin or barium dye (commonly referred to as upper GI): It allows for preoperative delineation of the anatomy and helps in identifying the presence and size of a hiatal hernia
  • EGD (esophago-gastro duodenoscopy, commonly referred to as upper GI endoscopy): It allows for a visualization of the oesophageal mucosa for GERD-related pathological changes
  • Oesophageal manometry: This method allows for an evaluation of oesophageal body function. It is also helpful in identifying conditions that might contraindicate Anti-Reflux Surgery (such as achalasia)
  • 24-hour pH monitoring (with catheter, or placement of a capsule in the lower oesophagus): This helps in identifying the intensity of the acid reflux. This test should be performed, when patients are “off” their medications that neutralize or suppress acid production
  • Impedance study will determine, if there is any bile reflux (non-acid reflux disease). This is performed, if patients have symptoms of reflux disease, but there is no acid reflux on 24-hour pH monitoring 
  • Gastric emptying study

Risks and complications during hiatal hernia repair surgical procedure

The possible risks or complications that may arise during the hiatal hernia repair surgery are:
  • Infection
  • Bleeding
  • Injury to the neighbouring structures
  • Pain
  • Discomfort
  • Anaesthetic complications
  • Need for further procedures
  • Pneumonia
  • Blood clot formation
  • Heart problems
  • Difficulty swallowing because the stomach is wrapped too high on the oesophagus, or is wrapped too tightly
  • The oesophagus sliding out of the wrapped portion of the stomach so that the valve (lower oesophageal sphincter) is no longer supported
  • Heartburn that recurs
  • Bloating and discomfort from gas build-up, because the person is not able to burp

Risks and complications after hiatal hernia repair surgical procedure

Post hiatal hernia repair procedure, the following complications may arise:
  • Wound infection of the surgical site
  • Difficulty in swallowing (dysphagia)
  • Bloating of the stomach
  • Recurrence of the hiatal hernia

Post-operative care needed after a hiatal hernia repair surgical procedure

At home, the following post-operative care is recommended, after a hiatal hernia repair procedure:
  • For few days after the surgery, have a diet consisting only of liquids or semi-solids or puree diet
  • Avoid strenuous physical activities before slowly getting back to your regular daily routine
  • Keep incision wounds clean and dry
  • Complete the prescribed course of medications
  • Avoid pain killers, unless prescribed
  • Avoid any possibilities of constipation take medication if required to do so (under physician’s advice)
  • The patient has to change the way of eating
  • Chew food thoroughly and eat more slowly to give the food time, to go down the oesophagus
  • Avoid carbonated beverages as it will increase the feeling of gas bloating and these patients cannot burp after surgery
  • Do not eat while lying down

Comments

user profile image
16-06-2017 07:55 AM

I was suffering from gastroesophageal reflux disease, then my doctor advised me to go through Hiatal Hernia Repair procedure for my betterment. Bit relieved after the process.

user profile image
31-10-2016 02:09 PM

I had suffered from hiatal hernia problem few years back. Then I went through Hiatal Hernia Repair procedure and now I am fine after the treatment.

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