Our Summary

This research paper discusses the complications associated with repairing a paraesophageal hernia (PEHR) - a condition where part of the stomach pushes up into the chest through an opening in the diaphragm. This type of operation is not only technically difficult but is also generally performed on older patients who may have other health issues, making the surgery riskier. The risks and post-surgery complications can vary greatly depending on how urgent the operation is and the size of the hernia. Apart from general risks related to any surgery, there are several specific complications such as hernia recurrence, issues related to the use of surgical mesh, stomach perforations, gastroparesis (a condition that affects the stomach muscles and prevents proper stomach emptying), lung-related issues, and others. The article reviews the frequency, identification, cause, and management of these specific complications.

FAQs

  1. What are the potential complications associated with Paraesophageal hernia repair (PEHR)?
  2. How does the size of the hernia and the acuity of the operation affect the morbidity and mortality following PEHR?
  3. What is the incidence of reherniation, mesh-related complications, perforation, and gastroparesis following PEHR?

Doctor’s Tip

One helpful tip a doctor might tell a patient about hiatal hernia repair is to follow all post-operative instructions carefully, including avoiding heavy lifting, sticking to a soft diet for a period of time, and taking prescribed medications as directed. It is important to attend all follow-up appointments with your healthcare provider to monitor your recovery and address any concerns or complications that may arise. It is also important to maintain a healthy lifestyle, including eating a balanced diet, staying active, and avoiding smoking and excessive alcohol consumption to promote healing and prevent future hernias.

Suitable For

Patients who are typically recommended for hiatal hernia repair include those with symptomatic paraesophageal hernias, symptomatic sliding hiatal hernias that do not respond to medical management, or patients with complications such as reflux, Barrett’s esophagus, or strictures. Additionally, patients with large hiatal hernias that are causing significant symptoms or complications such as volvulus or incarceration may also be candidates for surgery. It is important to consider the overall health and comorbidities of the patient when determining the best course of treatment for hiatal hernia repair.

Timeline

  • Before hiatal hernia repair:
  1. The patient may experience symptoms such as heartburn, chest pain, difficulty swallowing, regurgitation, and nausea.
  2. The patient may undergo diagnostic tests such as endoscopy, barium swallow, and pH monitoring to confirm the presence and severity of the hiatal hernia.
  3. The patient may be advised to make lifestyle changes, take medications, and undergo physical therapy to manage symptoms before considering surgical intervention.
  • After hiatal hernia repair:
  1. The patient will undergo the surgical procedure to repair the hiatal hernia, which may be done laparoscopically or through open surgery.
  2. The patient may experience some pain, swelling, and discomfort in the surgical area postoperatively.
  3. The patient will be advised to follow a specific diet and activity restrictions to aid in the healing process.
  4. The patient may need to attend follow-up appointments to monitor the healing process and ensure proper recovery.
  5. In some cases, the patient may experience complications such as reherniation, mesh-related issues, perforation, and gastroparesis, which may require further treatment and management.

What to Ask Your Doctor

  1. What are the risks and benefits of having surgery to repair my hiatal hernia?
  2. What is the success rate of hiatal hernia repair surgery?
  3. What type of surgery will be performed to repair my hiatal hernia?
  4. Will I need to stay in the hospital after the surgery? If so, for how long?
  5. What is the recovery process like after hiatal hernia repair surgery?
  6. Are there any potential complications or side effects associated with hiatal hernia repair surgery?
  7. How long will it take for me to fully recover from the surgery?
  8. Will I need to make any lifestyle changes or follow a specific diet after the surgery?
  9. Are there any alternative treatments for hiatal hernia that I should consider before opting for surgery?
  10. How often will I need follow-up appointments after the surgery to monitor my recovery and overall health?

Reference

Authors: Corbett JM, Eriksson SE, Sarici IS, Jobe BA, Ayazi S. Journal: Thorac Surg Clin. 2024 Nov;34(4):355-369. doi: 10.1016/j.thorsurg.2024.06.002. Epub 2024 Jul 18. PMID: 39332860