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Bachelor of Medicine and Surgery MBChB (UCT).
Fellow of South African College of Surgeons
Diploma in Obstetrics & Gynaecology
Laparoscopic Hiatal Hernia Repair: A Patient's Guide
What is a Hiatal Hernia?
A hiatal hernia occurs when the upper part of your stomach pushes up through an opening in your diaphragm, the large muscle that separates your abdomen from your chest. This opening is called the hiatus, and it is where your oesophagus (food pipe) passes through on its way to your stomach.
There are different types of hiatal hernias, but the most common is a "sliding" hiatal hernia, where the junction between the oesophagus and stomach slides up into the chest. A hiatal hernia can cause symptoms such as:
Heartburn- Regurgitation (bringing food or stomach acid back up into the mouth)
- Chest pain
- Difficulty swallowing
- Shortness of breath
- Belching
What is a Laparoscopic Hiatal Hernia Repair?
A laparoscopic hiatal hernia repair is a minimally invasive surgical procedure to correct a hiatal hernia. It is designed to pull the stomach back down into the abdomen and tighten the opening in the diaphragm to prevent the hernia from recurring. The surgery is done through several small incisions (cuts), rather than one large one, leading to less pain and a quicker recovery for most patients.
Indications: When is this procedure recommended?
A laparoscopic hiatal hernia repair is typically recommended for patients who have been diagnosed with a hiatal hernia and meet one or more of the following criteria:
- Significant or persistent symptoms: You are experiencing severe or frequent symptoms related to your hiatal hernia that are not effectively managed with lifestyle changes or medication.
- Complications from the hernia: The hernia is causing complications such as chronic inflammation of the oesophagus (oesophagitis), ulcers, or bleeding.
- Hernia type or size: You have a larger hernia (a paraoesophageal or mixed hernia) that carries a higher risk of complications, such as the stomach twisting or becoming trapped.
- In conjunction with anti-reflux surgery: The hiatal hernia is often repaired at the same time as a Laparoscopic Nissen Fundoplication if you also have severe gastroesophageal reflux disease (GERD).
Your doctor will perform a thorough evaluation, which may include an upper endoscopy, barium swallow study, or other imaging tests to determine if you are a good candidate for this surgery.
The Procedure: What to expect
- Preparation: Before the surgery, you will be given specific instructions regarding diet and medication. You will need to fast (not eat or drink) for a certain number of hours before the procedure.
- Anaesthesia: The surgery is performed under general anaesthesia, meaning you will be asleep and will not feel any pain.
- Laparoscopy: The surgeon will make several small incisions (usually 3 to 5) in your abdomen. Through these incisions, they will insert the laparoscope and other specialized surgical instruments. The abdomen is inflated with carbon dioxide gas to create space for the surgeon to work.
- Repairing the Hernia: The surgeon will carefully pull the stomach and any other herniated tissue back down into the abdomen. They will then use sutures to tighten the opening in the diaphragm (the hiatus) so that the stomach cannot push back up again. In some cases, a piece of surgical mesh may be used to reinforce the repair, especially for larger hernias.
- Fundoplication (if needed): If you also have GERD, the surgeon may perform a fundoplication, where the upper part of the stomach is wrapped around the lower oesophagus to create a new valve. This helps to prevent acid reflux.
- Closure: The instruments are removed, the gas is released, and the small incisions are closed with sutures or surgical glue.
Recovery
After the procedure, you will be taken to a recovery room for monitoring. Most patients are able to go home within one to two days.
- Pain Management: You will likely experience some discomfort at the incision sites, which can be managed with pain medication.
- Diet: You will be given a specific dietary progression plan, starting with liquids, then moving to soft foods, and eventually returning to a normal diet over several weeks. It is important to follow these instructions carefully.
- Activity: You should avoid heavy lifting and strenuous activity for several weeks to allow the surgical sites to heal. Your doctor will advise you on when you can safely return to your normal activities.
Risks and Complications
Like any surgical procedure, a laparoscopic hiatal hernia repair has potential risks. While serious complications are rare, they can include infection, bleeding, injury to the oesophagus or other organs, and the possibility of the hernia recurring. Your surgeon will discuss all the potential risks and benefits with you in detail.
Please note: The information provided above and on this website is for education and interest purposes only. It is not intended to replace a personal one-on-one consultation, nor is it meant to substitute professional medical advice, diagnose or treat any condition. A consultation with a specialist and qualified health care provider such as Dr. Mitchell or Dr. Munda is essential for correct diagnosis and management, as well as to answer any queries that you may have. Never disregard or delay in seeking professional medical advice due to something you have read on this website. Dr. Mitchell and Dr. Munda take no responsibility for any errors or omissions present on this website and they are not liable for any consequences that may occur from misinterpretation of the information on this website. In the event of uncertainty or an emergency, please visit your nearest casualty.