Indications for Hiatal Hernia Repair: Why Some Hernias Require Surgery

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Hiatal hernias, although seemingly unheard of, are quite commonly occurring. It happens when a tear or weakened portion of the diaphragm allows either a portion of the lower part of the esophagus or upper part of the stomach to protrude upward into the chest cavity. Symptoms often associated with hiatal hernias include frequent gastric acid reflux or heartburn that cannot be relieved by medications, pneumonia and esophageal inflammation, among many others. An estimated million cases of hiatal hernia repairs are performed worldwide every year. Hiatal hernia repair is a surgical procedure that can be done through open surgery or laparoscopic surgery.

Open Surgery

An open hiatal hernia repair procedure is usually done in an inpatient basis where the patient stays in the hospital for about six days. The patient undergoes general anesthesia during the surgery to render the whole body numb and unconscious for the rest of the procedure, which takes about 3 to 4 hours. During an open hiatal hernia repair, the surgeon usually makes a relatively large incision in the abdomen in order to locate the lower esophagus, stomach, and diaphragm. The displaced portions are first returned to their correct locations under the diaphragm, then the hole or hiatus in the diaphragm is sewn to decrease the extent of the opening so no future hernias will protrude back. Sometimes, fundoplication or the wrapping of the top part of the stomach around the lower portion of the esophagus is done to add pressure to the esophageal sphincter and reduce incidence of reflux. The recovery period is usually four to six weeks after the surgery. Patients are usually advised to eat small and frequent meals, and to avoid heavy lifting for up to three months.

Laparoscopic Procedure

A laparoscopic hiatal hernia repair procedure can be done in an outpatient or inpatient basis. If the patient prefers an inpatient basis, hospital stay is about two to three days. A regional or general anesthesia may be used, with the procedure taking approximately three hours to complete. For a laparoscopic hiatal hernia repair, instead of making one long cut, the surgeon makes three to five small incisions in the abdomen, where he inserts a laparoscope. A laparoscope is a thin hollow tube with a video camera inside. This allows the surgeon to see the inside of the abdomen and perform the operation using several devices inserted through the other incisions. The recovery time is usually two to three weeks after the procedure.

Risks and Complications

The open and the laparoscopic hiatal hernia repair procedure are invasive surgeries and often have the same risks and complications involved. These include allergic reaction to the anesthesia, bloating, bleeding, infection and pain. However the degree to which they can occur is often greater in an open surgery procedure.

References Hiatal Hernia Repair Laparoscopic Hiatal Hernia Repair Procedure Details