Hiatal Treatment

Hiatal hernia treatment surgery is a procedure to repair a hiatal hernia, which occurs when part of the stomach pushes through the diaphragm into the chest cavity through the hiatus, an opening in the diaphragm. Small hiatal hernias often cause no symptoms and may not require treatment, but larger ones can lead to acid reflux, heartburn, difficulty swallowing, chest pain, and other discomforts. When lifestyle changes and medications do not provide relief, surgery may be necessary to restore the stomach to its proper position and strengthen the diaphragm.

Types of Hiatal Hernia Surgery

1. Nissen Fundoplication:

   • Most Common Surgery: In a Nissen fundoplication, the surgeon wraps the upper part of the stomach around the lower esophagus. This prevents stomach acid from flowing back up into the esophagus and strengthens the lower esophageal sphincter.
   • Effective for Reflux Control: This procedure is effective in controlling GERD symptoms that are often associated with a hiatal hernia.
   • Laparoscopic Approach: Typically performed laparoscopically (minimally invasive), which reduces recovery time and postoperative pain.

2. Partial Fundoplication (Toupet or Dor Fundoplication):

   • Alternative to Nissen: In cases where a full wrap is not possible or would lead to side effects, a partial wrap may be performed, where only part of the stomach is wrapped around the esophagus.
   • Less Risk of Complications: This technique may be used for patients with esophageal motility issues or those at higher risk for swallowing difficulties.

3. Laparoscopic Hiatal Hernia Repair:

   • Minimally Invasive Repair: The surgeon makes small incisions and uses a laparoscope (a tiny camera) to guide the repair. The herniated portion of the stomach is pulled back into the abdomen, and the hiatus (the diaphragm opening) is tightened with sutures to prevent reherniation.
   • Mesh Reinforcement: In some cases, a mesh may be used to reinforce the weakened area, reducing the likelihood of recurrence.

4. Transoral Incisionless Fundoplication (TIF):

   • Non-Surgical Option: This incisionless approach uses an endoscope to repair the hiatal hernia and tighten the lower esophageal sphincter from within the esophagus.
   • Less Invasive: TIF has a shorter recovery time and is often considered for patients with mild to moderate hiatal hernias.

5. Paraesophageal Hernia Repair:

   • For Large Hernias: This procedure is specifically for paraesophageal hernias, where a larger portion of the stomach or other organs herniates alongside the esophagus, posing a risk of complications like strangulation.
   • Complex Surgery: The stomach and any other displaced organs are returned to their proper positions, and the hiatus is repaired to prevent recurrence.

Why Hiatal Hernia Surgery is Done

Hiatal hernia surgery is generally recommended if:

• Symptoms are severe, chronic, or not relieved by medication or lifestyle changes.
• Complications arise, such as esophagitis (inflammation of the esophagus), difficulty swallowing, or bleeding.
• The hernia is large and poses a risk of strangulation, where blood supply to part of the stomach is cut off.

Recovery and Life After Hiatal Hernia Surgery

• Recovery Time: Recovery from laparoscopic hiatal hernia surgery usually takes a few weeks, while open surgery may require a longer recovery period.
• Post-Surgery Care: Patients are advised to eat smaller, more frequent meals, avoid foods that trigger reflux, and gradually resume normal activities. Heavy lifting should be avoided during recovery.
• Success Rates: Hiatal hernia surgery is generally very effective, with a high success rate in reducing or eliminating symptoms of GERD and preventing hernia recurrence.

Surgical treatment for hiatal hernias allows patients to manage symptoms and complications, helping improve their quality of life and reduce the need for ongoing medication.