Our Summary

This research paper talks about a less invasive surgical procedure called oesophagectomy, which is commonly used but has been associated with a higher rate of hiatal hernias after surgery, compared to more traditional, open surgeries. The paper describes a case where a 71-year-old man had one of these hernias fixed using a laparoscopic technique (a type of minimally invasive surgery) and a biosynthetic mesh. The operation took two hours and the man was able to start eating the next day and was discharged from the hospital two days later. Six months after the operation, tests showed no signs of the hernia returning. The authors suggest that this laparoscopic technique should be the first choice for fixing hiatal hernias after a minimally invasive oesophagectomy because of its many benefits.

FAQs

  1. What is the rate of postoperative hiatus hernia after minimally invasive oesophagectomy?
  2. What is the suggested treatment for a symptomatic hiatus hernia post-minimally invasive oesophagectomy?
  3. What are the advantages of a laparoscopic approach to treat a symptomatic hiatus hernia post-minimally invasive oesophagectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hiatal hernia repair is to consider a laparoscopic approach, as it can offer numerous benefits such as shorter recovery time, less pain, and lower risk of complications compared to open surgery. Additionally, using a biosynthetic mesh during the repair can help prevent hernia recurrence. It is important to follow postoperative instructions closely and attend follow-up appointments to ensure proper healing and avoid future complications.

Suitable For

Patients who are typically recommended hiatal hernia repair are those who are symptomatic and have a large or giant hiatal hernia. In the case presented in the abstract, the patient had undergone minimally invasive oesophagectomy for distal adenocarcinoma of the oesophagus and developed symptomatic hiatus hernia postoperatively. In such cases, laparoscopic biosynthetic mesh repair may be recommended as it is associated with numerous advantages and can effectively address the hernia.

Timeline

  • Before the hiatal hernia repair:
  1. The patient undergoes minimally invasive esophagectomy for distal adenocarcinoma of the esophagus.
  2. One year after the esophagectomy, the patient develops symptoms of a giant hiatus hernia.
  3. The patient experiences symptoms such as heartburn, chest pain, difficulty swallowing, and regurgitation.
  • After the hiatal hernia repair:
  1. The patient undergoes laparoscopic biosynthetic mesh repair of the hiatus hernia.
  2. The operative time is 120 minutes.
  3. The patient is able to start oral intake on postoperative day one.
  4. The patient is discharged from the hospital on postoperative day three.
  5. Postoperative computed tomography at six months shows no signs of recurrence.
  6. The laparoscopic approach is preferred for its advantages in the setting of a symptomatic hiatus hernia post-minimally invasive esophagectomy.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with hiatal hernia repair surgery?
  2. How long is the recovery time after hiatal hernia repair surgery?
  3. Will I need to make any lifestyle changes or follow a specific diet after the surgery?
  4. How likely is it that the hernia will recur after the repair surgery?
  5. What type of anesthesia will be used during the surgery?
  6. Will I need to stay in the hospital after the surgery, and if so, for how long?
  7. How soon after the surgery can I resume normal activities and exercise?
  8. Will I need to take any medication after the surgery, and if so, for how long?
  9. Are there any long-term effects or complications associated with hiatal hernia repair surgery?
  10. How often will I need to follow up with you after the surgery for monitoring and to check for any potential issues?

Reference

Authors: Marchesi F, Dalmonte G, Morini A, Annicchiarico A. Journal: Ann R Coll Surg Engl. 2020 Jul;102(6):e130-e132. doi: 10.1308/rcsann.2020.0049. Epub 2020 Apr 24. PMID: 32326737