If Hiatal Hernia is in danger of causing strangulation or narrowing of the esophagus, so you must go for the surgery. Moreover, now a day’s laparoscopic procedures are in use which involves small incisions on the abdomen to repair the herniated part of the stomach with the least risk of complications and quicker recovery.
- 1 1) What is Hiatal Hernia?
- 2 2) Types of Hiatal Hernia:
- 3 3) Diagnosis:
- 4 4) When is surgery required?
- 5 5) What types of Surgeries are there?
- 6 6) Nissen Fundoplication (Keyhole Surgery):
- 7 7) Endoluminal Fundoplication:
- 8 8) Open Surgery:
- 9 9) Recovery Time:
- 10 10) Post-Surgery Diet Plan:
- 11 11) Take Home Advices:
- 12 12) Complications and Risks of Hiatal Hernia Surgery:
1) What is Hiatal Hernia?
Protrusion of a part of the stomach into the chest cavity through the esophageal hiatus of the diaphragm is called hiatal hernia. The prevalence of hiatal hernia increases with age with slight predilection in females. If hiatal hernia causes severe symptoms like GERD (gastroesophageal reflux disease), dysphagia, or chest pain then it is likely to cause complications such as strangulation, gangrene, gastric volvulus, obstruction, narrowing of the esophagus, or perforation then its surgery becomes unavoidable.
2) Types of Hiatal Hernia:
The following are the main types of Hiatal Hernia.
- Sliding hiatal hernia (the gastroesophageal junction is displaced)
- Para esophageal hiatal hernia (the gastroesophageal junction is not displaced)
- Mixed or compound hiatal hernia (the gastroesophageal junction is displaced)
- Mixed or compound type hiatal hernia with an additional displacement of other viscera.
A Hiatal Hernia does not bulge outward hence cannot be noticed. Therefore, Chest X-ray, upper gastrointestinal barium study, an MRI (Magnetic resonance imaging), a computerized tomography (CT) scan, and upper GI endoscopy are useful in diagnosing hiatal hernia.
4) When is surgery required?
Usually, Hiatal Hernia does not cause symptoms so, surgery is not required. In some cases it causes mild symptoms like heartburn, acid reflux, etc and this condition can be treated with medications such as proton pump inhibitors (Omeprazole, or Lansoprazole), antacids (Aluminium hydroxide, Magnesium hydroxide, or Sodium bicarbonate) or H-2 receptor antagonists (Famotidine, Cimetidine, or Ranitidine) and lifestyle changes such as avoiding late-night meals, elevating the head side of the bed, quitting the habit of smoking, avoiding the triggers such as alcohol, chocolate, deep-fried foods, etc.
Moreover, surgery becomes inevitable when:
- Symptoms stop responding to medical therapy.
- The hernia is causing any complications such as strangulation which refers to complete obstruction of blood supply to the herniated tissue. This condition can be fatal.
- Symptoms become severe, may include bleeding, and affect the quality of life.
5) What types of Surgeries are there?
Three types of surgeries are available for hiatal hernia. Nissen fundoplication (keyhole surgery), endoluminal fundoplication, and open repairs. All of these procedures can be done under general anesthesia.
6) Nissen Fundoplication (Keyhole Surgery):
The most commonly used procedure for hiatal hernia is Nissen fundoplication. Actually it is a laparoscopic procedure (minimally invasive) in which a surgeon will only make some small incisions on the abdomen.
The surgeon puts the laparoscope (a tube with a camera and light) into the abdomen to repair the herniated part of the stomach and tightens the stomach to prevent a recurrence.
Laparoscopic repair is superior to other procedures because of the following advantages.
- Minimal risk of infection.
- Less pain.
- Minimum scarring.
- Less hospital stay.
- Faster recovery.
- Least chances of recurrence.
7) Endoluminal Fundoplication:
This is a recently developed procedure and less invasive than Nissen fundoplication, but it is not commonly used. In this procedure, no incision is required because an endoscopic tube (with light and camera) will pass through the throat into the esophagus. The surgeon will tighten the gastroesophageal junction to prevent reflux. However, it is highly associated with recurrence.
8) Open Surgery:
In open surgery, a large incision is made in the abdomen so that the surgeon can repair the hernia. This procedure has more risks than laparoscopic procedures.
In this procedure, a surgeon will push the stomach back into the abdominal cavity and tie the upper portion of the stomach called fundus around the lower part of the esophagus to prevent gastric reflux. Sometimes, a tube is required to insert in the stomach to keep the stomach in the actual position. The tube will be removed after some weeks.
9) Recovery Time:
The laparoscopic surgeries are minimally invasive and result in a speedy recovery, so most of the people do not feel any pain but experienced a little discomfort in the abdomen or chest. They may also feel difficulty in swallowing. These symptoms usually resolve within 48 hours. The patient may be able to go home on the same day or the next day. While the open surgery procedure requires a longer hospital stay and prolonged recovery time.
10) Post-Surgery Diet Plan:
The patient must follow the given diet chart after surgery. The doctor will advise you to drink clear liquids just after surgery and then start soft or liquefied food such as white rice, egg noodles, mashed potatoes, or bananas, etc. The patient will be advised to take small meals throughout the day rather than three large meals. The patient must avoid those foods which can cause gas or bloat. Moreover, the patient can return to their normal regular diet after 3-6 weeks but the patients should continue to avoid acidic foods, carbonated drinks, or alcohol, etc.
11) Take Home Advices:
The doctor will advise to do the following things at home.
- Wash your incision area daily by using plain soap and water.
- Avoid the use of pools and hot tubs, use shower rather than the bathtub.
- Avoid drinking water or juices with the help of a straw.
- Try to walk daily for a few minutes to avoid deep vein thrombosis.
- Practice particular coughing and breathing exercises to make your diaphragmatic muscles stronger.
After a few weeks of surgery, your doctor will recommend you:
- To avoid driving for about 8 to 10 days.
- To avoid heavy weight lifting for almost 2 to 3 weeks.
- To rejoin their work after 2-3 weeks or when the patient may feel better.
- To take painkillers for a few days after surgery to reduce their discomfort.
12) Complications and Risks of Hiatal Hernia Surgery:
All surgeries carry risks either less or more. The main risks of Hiatal Hernia surgery include bleeding, injury to internal organs, or infection. However, the laparoscopic surgery minimizes these risks as compared to open surgery.
Common complications resulting from Hiatal Hernia surgery include:
- Dysphagia (difficulty in swallowing)
- Abdominal bloating.
- Difficulty in vomiting and belching.
- Recurrence of hernia or gastric reflux.
Cardiac complications if the hernia was large in size.