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Hiatus Hernia Surgery

What is a hiatus hernia repair surgery?

Hiatus hernia is a condition where part of the stomach is in the chest rather than the abdominal cavity. They are very common and if small may cause no symptoms or symptoms of gastro-oesophageal reflux. Large hiatus hernia can cause difficulty swallowing, severe reflux and can even cause the stomach to twist into a knot. 

Hiatus hernia surgery is when the stomach is drawn don from the chest and replaced in the abdominal cavity before the defect (hernia) in the diaphragm is repaired.

What are the symptoms of a hiatus hernia?

Most people with small hiatus hernia will have little or no symptoms. When people have symptoms, they may experience GORD, acid reflux, regurgitation or vomiting. Large hiatus hernias may cause severe reflux vomiting or difficulty swallowing.

Why consider hiatus hernia repair surgery?

When a hiatus hernia becomes clinically symptomatic you may be referred to a specialist to have a discussion regarding surgery. Surgery should be considered if Hiatus hernia is resulting in 

  • severe reflux symptoms, 
  • reflux that impairs your quality of life, 
  • Difficulty swallowing (dysphagia)
  • complications of reflux (bleeding, strictures, inflammation of the oesophagus) 
  • in some circumstances, such as large hiatus hernia, reduce the risk of twisting (strangulation) 

How is hiatus hernia repair surgery performed?

Almost all hiatus hernia surgery can be repaired via a minimally invasive/ keyhole or laparoscopic approach. There will always be exceptions and there is always a chance that if surgery is too dangerous to be performed with keyhole then the traditional open surgery method will be employed. Alternatively, it is possible to use the Da Vinci robot to perform this procedure and studies from the united states have shown that the results are similar to laparoscopic keyhole surgery.

A laparoscopic Hiatus hernia repair is performed by first making 5 small (keyhole) incisions on the abdominal wall for the surgical ports. Low pressure carbon dioxide gas is used t inflate the abdomen. Specialised laparoscopic instruments a camera and liver retractor are placed through the ports to expose the stomach and diaphragm. The stomach is drawn down from the chest to its correct position in the abdomen. The attachments of the hiatus hernia sac are released from the diaphragm so that the stomach sits in the abdomen without tension. The large defect if (hernia) in the diaphragm is closed with strong sutures and then the oesophagus and stomach are resecured to the diaphragm. Some patients with reflux symptoms may also have a fundoplication performed, before the gas is removed and the incisions are closed with dissolvable stitches

Will I need to have a mesh placed to repair my hiatus hernia?

Most people will not require the placement of a mesh to reinforce their hiatus hernia repair. Sometimes mesh maybe required if the gap in the diaphragm muscle is very large or if the tissues are very weak.

What are the risks of laparoscopic hiatus hernia surgery?

In addition to the risks of all operations, there is a risk that people may experience swallowing difficulties after surgery, a small proportion may experience bloating and some increased flatulence. Intra operative risks include damage to the oesophagus, nerves that supply the stomach or damage to the spleen

How long does hiatus hernia surgery take?

Laparoscopic hiatus hernia surgery will usually take between 2-4 hours depending on the size of the hiatus hernia

Is hiatus hernia surgery covered by health insurance?

Yes, in general, hiatus hernia surgery and keyhole surgery are covered by private hospital health insurance policies. However, we suggest checking with your health insurer prior to any hospital admission or procedure.

What is the recovery after hiatus hernia surgery?

  • Yes, but you will need to alter your diet for the first few weeks after surgery. While the swelling from the surgery at the top of the stomach settles down you will need to eat a soft diet. This means no large chunks of meat, veg or bread. It is also best to avoid carbonated or fizzy drinks. After 2-3 weeks normal diet may be resumed
  • Most people will stay one or two nights in hospital following this type of surgery. You may need to stay in hospital for a longer period if your surgery is complex or you experience a complication.
  • Most people will not feel like exercising for the first week after surgery. After this we would recommend lots of walking or light aerobic work from around week 2. At four weeks, swimming, jogging and visits to the gym are permitted if heavy weight lifting or straining is avoided.
  • Return to work depends on your job, the tasks you are required to perform, your general health and your employer. Most people who are not required to lift heavy objects can return to work 2 weeks following surgery. People who have jobs which involve heavy lifting may need to have 6 weeks off work.

Will I need a fundoplication with my hiatus hernia surgery?

Fundoplication (folding of the stomach) is often performed with hiatus hernia surgery, especially if people have significant Reflux prior to surgery. However, if difficulty swallowing is the issue then no fundoplication is performed. For more information follow this link https://www.keyholesurgeon.com.au/laparoscopic-anti-reflux-surgery.html