Hiatal Hernia Repair
A hiatal hernia is when a portion of the stomach enters the chest cavity. The stomach enters the chest through the opening where the esophagus passes through the diaphragm and into the abdomen. This is abnormal. There are four types of Hiatal hernias all of which could necessitate surgical intervention.
It is theorized that this occurs due to high intra-abdominal pressure from coughing, obesity, pregnancy, and heavy lifting to name a few. These hernias are more common in the elderly, ages 60-70 years old. Some patients are asymptomatic. Those who do develop symptoms include acid reflux, bloating, abdominal discomfort, regurgitation, the sensation of “stuck” food, coughing, and shortness of breath. Very rarely, Hiatal hernias may cause obstruction of the stomach resulting in sudden abdominal pain, nausea, and vomiting.*
A hiatal hernia is repaired in four steps:
- Reduce the stomach back into the abdomen
- Remove the hernia sac
- Close the muscles of the diaphragm (with stitches +/- rare mesh)
- Fixation of the stomach by wrapping the native stomach around the esophagus is called Fundoplication
The most common approach to this surgery is through small incisions either performed laparoscopically or robotically.
For patients with Morbid obesity, BMI > 35, a hiatal hernia repair with Fundoplication is not the preferred method of repair due to the high risk of recurrence. These patients can pursue natural or Medical Weight Loss and re-assess their candidacy or are a candidate for a Roux-en-Y Gastric Bypass which can be discussed with your surgeon at the time of your consultation.
*If obstructive symptoms are present you should go to your nearest Emergency room immediately*