Dr Sewell has extensive experience in the laparoscopic repair of both initial and recurrent hiatal hernias. If you have been told that the re-operation can only be done with an open surgery technique, he would be happy to provide you with a second opinion before you have anything done.
Most patients who have been diagnosed with a hiatal hernias experience one or more symptoms on a regular basis. They may also be under the impression that they have no choice but to live with their symptoms. However, defects in the diaphragm can and often should be surgically repaired as a means of controlling the symptoms. Huge defects in the diaphragm can result in a twisting or obstruction of the stomach with symptoms ranging from nausea and persistent vomiting of undigested food, to weight loss and even malnutrition. Ulcerations can also occur within the herniated portion of the stomach and are a common source of upper GI bleeding and chronic anemia.
The diaphragm is a broad, flat muscle that separates the chest cavity from the abdominal cavity. It moves up and down when you breathe, creating negative pressure in the chest cavity. The esophagus passes through a small opening in the diaphragm called the hiatus. If this opening becomes stretched, some or all of the stomach is pulled up into the chest cavity. This condition is called a hiatal hernia. While the majority of hiatal hernias are relatively small, with only the upper part of the stomach sliding up through the diaphragm, they often become larger over time. If the hernia becomes large enough, the entire stomach and even other abdominal organs can become permanently displaced above the diaphragm.
Following surgery your diet will need to be restricted for a few weeks to allow the swelling around the esophagus to resolve. Click HERE to see the post-operative diet instructions.
Recurrent Hiatal Hernia Repair
Occasionally, despite what was an initially an effective repair, the hiatal hernia can come back. This may be due to excessive retching or vomiting, heavy lifting or straining, or in some cases for no apparent reason. The symptoms of a recurrent hiatal hernia include chest pain, typically through into the back, indigestion or heartburn, and occasionally even trouble swallowing. Having a recurrence of the hernia is obviously disappointing, but the good news is it can generally be repaired again using the same minimally invasive procedure. A recurrence is more likely if the initial hernia was very large. The routine use of some type of mesh material to strengthen the diaphragm closure is generally recommended, especially for larger or recurrent hiatal hernias to reduce the chances of the hernia coming back. The most commonly used type of mesh is made of biological materials rather than any type of plastic. This reduces the risk of mesh problems down the road. But, if the defect in the diaphragm is extremely large, it may require placement of mesh made of artificial materials.
Minimally Invasive Surgery
Laparoscopic surgery can offer patients with a hiatal hernia a minimally invasive repair that typically only requires an overnight stay in the hospital. Even very large hernias can usually be repaired in this way by an experienced laparoscopic surgeon. In rare cases the stomach may not be able to be completely mobilized out of the chest cavity due to a shortened esophagus. In these rare situations an esophageal lengthening procedure, known as a Collis Gastrostroplasty may need to be performed before the hernia can be repaired.
As a final part of virtually any hiatal hernia repair, the top part of the stomach is wrapped around the lower esophagus creating what is called a fundoplication. This helps prevent problems with gastric reflux after surgery and further reduces the chances of the hernia coming back.
Symptoms of Hiatal Hernia
The most common symptoms of hiatal hernia include: