Our Summary

An esophageal hiatal hernia is a medical condition where the stomach pushes up through an opening in the diaphragm muscle (known as the esophageal hiatus) into the chest cavity. To treat this, surgeons must move the stomach back into its correct position, stitch up the widened opening in the diaphragm, and secure the stomach in place to prevent acid reflux.

In Japan, the recommended surgical procedure for this condition is called laparoscopic Toupet fundoplication. This involves small incisions and specialized tools to make the surgery less invasive. In this procedure, surgeons need to carefully consider where to make the incisions to easily reach the stomach and diaphragm opening.

We have found that removing the hernia sac (the part of the stomach that has pushed through) from the left side is most effective. For older patients, it’s important not to wrap the stomach too tightly during the procedure to prevent difficulty swallowing afterward.

Possible complications after surgery include pneumonia caused by food or drink entering the lungs, slow stomach emptying, and narrowing of the esophagus. Therefore, it’s crucial for surgeons to have a good understanding of the body’s normal structure and the specific circumstances causing the hernia. This knowledge allows them to perform a careful and effective surgery.

FAQs

  1. What is a hiatal hernia and how is it surgically treated?
  2. What is the recommended procedure for hiatal hernia repair according to the Japanese guidelines for GERD treatment?
  3. What are the potential postoperative complications of a hiatal hernia repair?

Doctor’s Tip

One helpful tip a doctor might tell a patient about hiatal hernia repair is to follow post-operative instructions carefully, including avoiding heavy lifting and strenuous activities for a certain period of time to allow for proper healing. It is also important to follow a diet plan recommended by the doctor to prevent complications such as reflux or difficulty swallowing. Additionally, keeping regular follow-up appointments with the doctor is crucial to monitor recovery progress and address any concerns or complications that may arise.

Suitable For

Patients who are typically recommended for hiatal hernia repair are those who have symptomatic hiatal hernias that are causing complications such as gastroesophageal reflux disease (GERD), difficulty swallowing, chest pain, or respiratory issues. Patients who have failed to respond to conservative treatment options such as medications or lifestyle modifications may also be candidates for surgical repair. Additionally, patients with large hiatal hernias, paraesophageal hernias, or those with complications such as Barrett’s esophagus or esophageal strictures may also be recommended for surgical intervention. Overall, the decision to undergo hiatal hernia repair should be made on a case-by-case basis in consultation with a healthcare provider.

Timeline

Before the hiatal hernia repair, a patient may experience symptoms such as heartburn, chest pain, difficulty swallowing, regurgitation of food or liquids, and feeling full quickly after eating. They may undergo diagnostic tests such as an upper endoscopy, barium swallow, or pH monitoring to confirm the presence of a hiatal hernia.

After the hiatal hernia repair, the patient can expect a recovery period that may include pain and discomfort at the incision sites, difficulty swallowing, bloating, and gas. They will be advised to follow a specific diet, avoid heavy lifting or strenuous activities, and take prescribed medications as directed. Follow-up appointments with the surgeon may be scheduled to monitor the healing process and address any concerns or complications that may arise. With proper care and adherence to post-operative instructions, most patients can expect to experience relief from their hiatal hernia symptoms and improved quality of life.

What to Ask Your Doctor

  1. What are the risks and benefits of hiatal hernia repair surgery?
  2. What is the success rate of the surgery in terms of symptom relief and prevention of complications?
  3. What is the recovery process like after hiatal hernia repair surgery?
  4. Will I need to make any lifestyle changes or follow a special diet after the surgery?
  5. How long will it take for me to fully recover and return to normal activities?
  6. Are there any alternative treatment options for hiatal hernia that I should consider?
  7. How often will I need to follow up with you after the surgery?
  8. What signs or symptoms should I watch for that may indicate a complication after the surgery?
  9. Will I need to take any medications long-term after the surgery?
  10. Are there any specific exercises or physical therapy that may help with my recovery after hiatal hernia repair surgery?

Reference

Authors: Nakajima M, Kojima K. Journal: Kyobu Geka. 2024 Sep;77(10):891-895. PMID: 39617390