Our Summary

The purpose of this research paper is to discuss the procedure of repairing a type of hernia known as Paraesophageal Hernia (PEH) through the chest (transthoracic approach). In the past, this was a common method, but it has been largely replaced by less invasive types of surgery that are done using a laparoscope (a small tube with a light and camera that allows surgeons to see inside the body without making large incisions). However, the authors argue that for experienced surgeons, the original chest approach can still have advantages in certain situations. They outline these specific circumstances and provide details about the important parts of successfully performing this type of hernia repair.

FAQs

  1. What are the benefits of the transthoracic repair for hiatal hernias?
  2. What are some of the important steps in performing a successful transthoracic PEH repair?
  3. Why has the transthoracic approach to PEH repair been displaced by laparoscopic methods?

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, sticking to a soft diet, and taking prescribed medications as directed. It is important to follow up with your doctor for any concerns or complications that may arise after surgery.

Suitable For

The types of patients typically recommended for hiatal hernia repair include those with symptomatic paraesophageal hernias, recurrent hiatal hernias after previous repair, large hiatal hernias, and patients with complications such as volvulus or incarceration. Additionally, patients with severe symptoms such as dysphagia, reflux, chest pain, or respiratory issues may also be candidates for hiatal hernia repair. It is important for the surgeon to carefully evaluate each patient’s individual case to determine the most appropriate treatment approach.

Timeline

Before hiatal hernia repair:

  1. The patient may experience symptoms such as heartburn, chest pain, difficulty swallowing, and regurgitation.
  2. The patient undergoes various diagnostic tests such as endoscopy, barium swallow, and esophageal manometry to confirm the presence of a hiatal hernia.
  3. The patient may be prescribed medication to manage symptoms and advised to make lifestyle changes such as losing weight and avoiding trigger foods.

After hiatal hernia repair:

  1. The patient undergoes surgery to repair the hiatal hernia, either laparoscopically or transthoracically, depending on the surgeon’s preference and the patient’s condition.
  2. Following surgery, the patient may experience some pain and discomfort at the incision site, which can be managed with pain medication.
  3. The patient will be advised to follow a diet plan to prevent straining the surgical site and to promote healing.
  4. The patient will have follow-up appointments with their surgeon to monitor their recovery and address any concerns or complications that may arise.

What to Ask Your Doctor

  1. What is a hiatal hernia and why do I need surgery to repair it?

  2. What are the risks and benefits of the transthoracic approach compared to laparoscopic methods for hiatal hernia repair?

  3. How experienced are you in performing transthoracic hiatal hernia repairs?

  4. What are the expected outcomes and recovery time following a transthoracic hiatal hernia repair?

  5. Will I need any additional procedures, such as a Collis gastroplasty, during the repair?

  6. What are the potential complications of the transthoracic hiatal hernia repair procedure?

  7. How long will I need to stay in the hospital after the surgery?

  8. What type of diet and lifestyle changes will I need to make following the surgery to prevent recurrence of the hiatal hernia?

  9. Will I need to follow up with a specialist or have any additional tests after the surgery?

  10. Are there any alternative treatment options for my hiatal hernia that I should consider before proceeding with surgery?

Reference

Authors: Reinersman JM, Deb SJ. Journal: Thorac Surg Clin. 2019 Nov;29(4):437-446. doi: 10.1016/j.thorsurg.2019.07.001. PMID: 31564401