Cardiovascular and Thoracic Surgery

Hiatal (Para-esophageal) Hernia

A hiatal hernia occurs when part of your stomach pushes upward through your diaphragm. Your diaphragm normally has a small opening (hiatus) through which your food tube (esophagus) passes on its way to connect to your stomach. The stomach can push up through this opening and cause a hiatal hernia.

Certain types of severe hiatal hernias—known as paraesophageal hernias, in which the stomach slides into the chest—are also treated using laparoscopy instead of opening up the chest through the rib cage.

Symptoms

Most small hiatal hernias cause no signs or symptoms. Larger hiatal hernias can cause signs and symptoms such as heartburn, belching, difficulty swallowing and fatigue.

Treatment

Surgery for hiatal hernia involves gently pushing the stomach or other organs back into place through the diaphragmatic opening (hiatus) and repairing this opening to close and tighten it and prevent future herniation. The surgeon stitches the hiatus to create a snug entry at the gastroesophageal juncture. The team may use special surgical mesh to help reinforce larger areas when it closes the diaphragm. To prevent the stomach from migrating upwards during healing, the surgeon may also suture the stomach to connective tissue in the abdomen, or place into the stomach a feeding tube that exits through the skin of the abdomen.

During this minimally invasive, laparoscopic procedure, the surgeon makes several very small incisions in the abdomen, through which the team inserts the scope and laparoscopic instruments. Surgery for hiatal hernias serves to reinforce the position and function of the esophageal sphincter, thus helping to address symptoms of reflux. In the same operation, the surgical team will sometimes also combine the fundoplication procedure used to treat severe reflux, for patients who may need an additional step in addressing a reflux condition. In this procedure, the surgeon wraps the upper portion of the stomach around the stomach-esophageal connection to tighten the separation between the two areas.

Patients who undergo laparoscopic surgery will spend at least one night in the hospital compared with patients who undergo open surgery, who will need to stay several nights in the hospital. Most patients are mobile the day after their surgery, are able to resume activities within a week, and are able to make a complete recovery within two to three weeks (twice this for open surgery). Strenuous exertion, though must be avoided for several months. This minimally invasive approach results in less scarring and pain, faster healing, and quicker recovery.

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