Our Summary

This research paper talks about a unique medical case of a 70-year-old man who was found to have early-stage stomach cancer located in the lower, narrow section of the stomach (known as the pylorus) alongside a type of hernia (hiatal hernia). The doctors performed a specific type of minimally invasive surgery (Endoscopic Submucosal Dissection or ESD) to treat the cancer.

But, after this procedure, the patient developed pyloric stenosis, a condition where the opening from the stomach into the small intestine narrows, causing the hernia symptoms to worsen. To treat these complications, the doctors performed a laparoscopic (minimally invasive) surgery to repair the hernia, a procedure called Toupet fundoplication (to improve the function of the valve between the stomach and esophagus), and Heineke-Mikulicz pyloroplasty (a surgery to widen the pylorus) all at the same time.

The patient recovered well after the surgery and didn’t face any issues during the follow-up period. This combination of surgeries for treating such a case has not been reported earlier in medical literature.

FAQs

  1. What is endoscopic submucosal dissection (ESD) and how is it used in treating hiatal hernia?
  2. What complications can occur post-ESD in hiatal hernia treatments?
  3. What is the role of laparoscopic hiatal hernia repair, fundoplication, and pyloroplasty in treating hiatal hernia and post-ESD pyloric stenosis?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hiatal hernia repair is to follow post-operative instructions carefully, including dietary restrictions and activity limitations. It is important to avoid heavy lifting and strenuous activities for a certain period of time to allow for proper healing. Additionally, maintaining a healthy diet and weight can help prevent the recurrence of hiatal hernias in the future. Regular follow-up appointments with your healthcare provider are also important to monitor your recovery progress and address any concerns.

Suitable For

Patients who are typically recommended for hiatal hernia repair include those with symptomatic hiatal hernias, such as gastroesophageal reflux disease (GERD), difficulty swallowing, chest pain, or regurgitation. Patients with complications of hiatal hernias, such as Barrett’s esophagus, esophagitis, or aspiration pneumonia, may also be recommended for surgical repair. Additionally, patients with large hiatal hernias that are causing significant symptoms or complications, such as gastric volvulus or severe reflux, may also be candidates for repair. In some cases, patients with hiatal hernias and early gastric cancer may undergo surgical repair in conjunction with treatment for the cancer, as described in the case study above.

Timeline

  • Patient presents with symptoms of a hiatal hernia and is referred to the hospital
  • Endoscopy reveals early gastric cancer in the pylorus
  • Endoscopic submucosal dissection (ESD) is performed to remove the cancer
  • Post-ESD pyloric stenosis occurs, worsening symptoms of the hiatal hernia
  • Laparoscopic hiatal hernia repair with Toupet fundoplication and Heineke-Mikulicz pyloroplasty is performed
  • Patient has a good postoperative course and follow-up after discharge is uneventful

What to Ask Your Doctor

  1. What is the best treatment option for my hiatal hernia repair considering my specific case and medical history?
  2. What are the risks and potential complications associated with the surgical procedure for hiatal hernia repair?
  3. How long is the recovery time after hiatal hernia repair surgery?
  4. Will I need to make any lifestyle changes or follow a special diet after hiatal hernia repair surgery?
  5. What are the success rates for hiatal hernia repair surgery in patients with similar conditions?
  6. How will my symptoms of hiatal hernia, such as acid reflux and heartburn, be managed after the surgery?
  7. Are there any alternative treatments or procedures available for hiatal hernia repair that I should consider?
  8. How often will I need follow-up appointments after hiatal hernia repair surgery, and what will be monitored during these appointments?
  9. Can you provide me with information about the experience and success rates of your surgical team in performing hiatal hernia repair procedures?
  10. Are there any specific precautions or activities I should avoid after hiatal hernia repair surgery to ensure a successful outcome?

Reference

Authors: Kubota T, Idani H, Ishida M, Choda Y, Nakano K, Shirakawa Y, Shiozaki S. Journal: Asian J Endosc Surg. 2021 Oct;14(4):782-785. doi: 10.1111/ases.12919. Epub 2021 Feb 5. PMID: 33547758