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HIATUS HERNIA REPAIR

The oesophagus runs through the diaphragm to the stomach and carries food from the mouth to the stomach. The oesophagus passes through the diaphragm just before it meets the stomach, through an opening called the oesophageal hiatus. When the opening (hiatus) in the muscle between the abdomen and chest (diaphragm) is too large, some or all of the stomach (can also include a portion of bowel) can slide up into the chest cavity.

This can cause heartburn (gastro-oesophageal reflux: GORD) as gastric acid backflows from the stomach into the oesophagus, pain and breathlessness especially after eating due to the reduced space in the thoracic cavity.

Increased pressure in the abdomen caused by:

Obesity

Pregnancy

Coughing

Straining during bowel movements

Congenital defect

More common in women and those over 50

Symptoms of Hernia
Common symptoms of Hernia are

Heartburn/GORD

Chest pain

Epigastric pain

Dysphagia – difficulty swallowing

Chronic cough

Shortness of Breath

Stomach Ulcer

Complications of Hernia
Patients with large or symptomatic hiatal hernias will often require surgery to repair the hernia. When a hernia begins to cause symptoms (chest pain, upper abdominal pain, difficulty swallowing), they are usually repaired. Symptomatic paraesophageal hernias are at higher risk for progressing to incarceration (stomach becomes constricted resulting in obstruction) or ischemia (blood supply to the stomach is cut off) resulting in the need for emergency surgery.

Most paraesophageal hernias can successfully and safely be repaired laparoscopically (with about 4 very small incisions) and through the abdomen (rather than the chest cavity). The laparoscopic repair of large paraesophageal hernias is a complex procedure and should only be attempted by an expert laparoscopic surgeon with extensive experience in laparoscopic upper GI surgery.

During surgery, the stomach (may include some bowel) is moved back into the abdominal cavity. The diaphragm at the oesophageal hiatus is closed to prevent the stomach from re-herniating into the chest cavity. A special kind of mesh is used to close the diaphragm appropriately. Once the diaphragm has been repaired, patients undergo a fundoplication or a ‘wrap’. The fundoplication is performed to further assist in keeping the stomach from herniating back into the chest cavity.

Patients spend on average 3 to 7 days in the hospital after surgery. Patients are required to follow a specific diet after surgery while they recover and will need to see our dietitian for dietary instructions prior to surgery. Commonly patients will be required to consume a fluid only diet for two weeks then progress onto two weeks of a puree diet and then onto a soft diet for a further two weeks before progressing back to a solid diet at the six-week mark. Small, frequent feedings are recommended.

Sutures are dissolvable and buried under the skin, dressings can stay on for 7 days. A follow-up appointment with your surgeon will be made for 3 weeks after surgery. Heavy lifting and vigorous exercise should be avoided for 6 weeks after the surgery.

GP review 2 weeks and specialist in 6 weeks