A hiatal hernia develops when a portion of your stomach migrates upward through your diaphragm, and may require hiatal hernia repair. Your diaphragm is a large, dome-shaped muscle that separates the chest cavity and abdomen and has a small opening called the hiatus. The hiatus is where your food tube (esophagus) passes to connect to your stomach. If the muscles surrounding the hiatus become weak, the upper portion of your stomach can push up through the diaphragm and into your chest cavity.
There are two types of hiatal hernias. When part of the stomach protrudes through the hiatus (opening in your diaphragm), leaving the gastroesophageal junction in its proper place, this is called a paraesophageal hernia. A sliding hernia occurs when parts of both the gastroesophageal junction and the stomach protrude through the hiatus. It is believed that symptoms associated with a paraesophageal hiatal hernia have the potential to be more severe.
To learn more about hiatal hernia repair, contact our office today. We are available to answer any questions that you might have.
Physicians might recommend surgical repair in patients who have a paraesophageal hernia, as a high percentage of these patients develop a strangulated hernia. This is a serious condition and can result in the puncture or tearing of the digestive tract and may be fatal. To prevent this, a hiatal hernia repair is performed. Other reasons this procedure may be recommended include:
Traditionally, surgeons have performed a hiatal hernia repair via an open surgery, which requires a larger incision to the abdomen or chest wall area. This more invasive approach is associated with a greater risk for complications, increased pain and risk for infection, and a much longer recovery time. Surgeons are now more prone to use a laparoscopic approach, which is minimally invasive, and results in decreased pain, complications, and scarring, as well as a quicker recovery.
To perform a laparoscopic hiatal hernia repair, your surgeon will make a few small incisions in your abdomen. You will be under general anesthesia so you will be asleep and pain-free. A laparoscope that allows your surgeon to see inside your abdomen and surgical instruments are then inserted through these incisions. The laparoscope transmits a picture of your internal organs to a monitor, which guides your surgeon.
During the procedure, your stomach and lower esophagus are guided back into your abdominal cavity. The hiatus (opening in the diaphragm) is then tightened and your stomach is stitched to prevent reflux. To prevent your stomach from migrating upward during the healing process, your surgeon may suture your stomach to connective tissue in your abdomen. To further reduce reflux, the upper part of your stomach may be wrapped around your esophagus. Your doctor can clearly explain the procedure to you so that you know what to expect.
In order to properly prepare for your procedure, your doctor will give you instructions that are specific to your situation. Make sure to follow these instructions carefully so that you are less likely to experience any types of complications.
You may awaken with a nasogastric tube, a tube placed into your stomach through your nose to help drain fluids and air from your stomach. This is typically removed the next morning. The typical hospital stay is one to three days.
You will have some discomfort after this procedure, mainly due to the “gas” that is used to inflate your abdomen during surgery. You will be prescribed a pain medication, but the best way to get rid of this pain is to walk. Your surgeon may prescribe a stool softener for you as well. It is important to take this as ordered and get an adequate fluid intake to prevent episodes of constipation.
Care for your incisions as directed by your surgeon. You should keep them clean with soap and water. Generally, you can shower 48 hours after your procedure. Avoid wearing tight or restrictive clothing as this can irritate your incisions.
At times, patients are given diet restrictions following surgery. If so, you will likely receive instructions from a dietitian prior to your discharge or receive written information to go over. You are encouraged to call your dietitian if you have any questions.
The majority of patients are able to get up and walk around the same day as surgery. Normal activity usually can be resumed within a week. Your complete recovery time will take two to three weeks. It is important to refrain from strenuous activities and heavy lifting for three months following your hiatal hernia repair.
Your doctor will provide you with instructions that are specific to you and your procedure. It is very important to follow these instructions carefully to ensure that your recovery goes as smoothly as possible.
Paraesophageal hiatal hernias may become trapped in the chest and unable to migrate back down to your abdomen. This is called strangulation and the blood supply could potentially be cut off to your hernia. The strangulated parts of your hernia may begin to die from not receiving adequate oxygen supplied by your blood. Should this condition occur, you will notice a sudden, sharp pain in your chest. You may also have difficulty swallowing. Immediate medical attention should be sought in this urgent medical situation.
You should also call your doctor immediately if you have been diagnosed with a hiatal hernia and experience pain in your abdomen, nausea or vomiting, or difficulty passing gas or having a bowel movement. These may be signs of an obstruction and will require a hiatal hernia repair.
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