The surgical repair of a hiatus hernia, a condition where a portion of the stomach pushes through the diaphragm into
the chest cavity, is a significant medical procedure aimed at alleviating symptoms and preventing complications. This
hernia primarily occurs at the opening of the diaphragm where the esophagus connects to the stomach, known as
the hiatus.
Hiatus hernias are classified into two main types:
Sliding hernia:where the gastroesophageal junction and part of the stomach slide into the chest, are
more common and often less severe. Rolling or Paraesophageal hernias:although less common, are more concerning as the stomach or
other abdominal organs herniate beside the esophagus and can lead to serious complications like
strangulation or obstruction of the stomach.
Surgery is usually considered when patients have significant symptoms that do not respond to medical management,
such as severe gastroesophageal reflux disease (GORD), chronic anemia from esophageal ulcers, or evidence of
strangulation or obstruction. It's also considered in cases of large paraesophageal hernias due to their potential for
complications, even in asymptomatic patients.
The most common surgical approach for repairing a hiatus hernia is laparoscopic surgery, which is minimally
invasive, well-established and effective treatment for patients with symptomatic or complicated hernias. This
technique involves small incisions in the abdomen through which surgical instruments and a camera are inserted.
The surgeon then pulls the stomach back into the abdomen, reconstructs the hiatus to prevent re-herniation, and
often performs a fundoplication. This is where the upper part of the stomach (the fundus) is wrapped around the
lower end of the esophagus to reinforce the valve between the esophagus and stomach, thereby preventing reflux.
The recovery from laparoscopic surgery is generally quicker, with less postoperative pain and a shorter hospital stay
compared to open surgery. Patients usually return to their normal activities within a few weeks, but full recovery can
take longer. Dietary modifications and follow-up care are crucial for successful outcomes.
In more complex or repeat cases, open surgery might be required. This involves a larger incision in the upper part of
abdomen or chest for direct access to the hernia.
Surgical repair of hiatus hernia is generally safe and effective, with a high rate of symptom relief and low recurrence
rates. However, as with any surgery, there are risks including infection, bleeding, and complications related to
anesthesia. Postoperative complications specific to this surgery include difficulty swallowing (dysphagia) and gas-
bloat syndrome. Patient selection, surgical expertise, and appropriate postoperative care are key to ensuring optimal
outcomes.