Laparoscopic Treatment of Hiatal Hernia
Hiatal Hernia
A hiatal hernia is the herniation (sliding) of a portion of the gastric fundus—sometimes small, sometimes large—into the thoracic cavity through the natural hiatus through which the oesophagus descends into the abdomen.
It is a condition that is often diagnosed late.
It causes symptoms such as:
• Pain in the upper abdomen
• Regurgitation of food with burning sensation, which may progress to vomiting; symptoms typically worsen when bending forward. Patients often use multiple pillows during sleep.
Physicians today seek to identify the condition primarily through upper gastrointestinal endoscopy.
Endoscopic findings may include:
• Presence of a hiatal hernia
• Oesophagitis of varying severity due to reflux
• A precancerous state (Barrett’s oesophagus)
When a hiatal hernia is diagnosed, and once conservative treatment has been exhausted, if:
• Symptoms do not subside,
OR
• A precancerous condition such as Barrett’s oesophagus is present,
the patient MUST undergo surgical treatment. A fundoplication must be performed—specifically, repositioning of the stomach into the abdomen and creation of a valve mechanism from the gastric fundus in order to prevent reflux (regurgitation) of gastric contents into the oesophagus.
How?
Today, the operation is performed laparoscopically—the established LAPAROSCOPIC FUNDOPLICATION, most commonly the NISSEN technique.
The patient must undergo evaluation by a gastroenterologist.
The procedure is performed under general anesthesia using highly advanced, state-of-the-art technological equipment and instruments.
Only four or five small skin incisions (5–10 mm) are required, through which the laparoscopic fundoplication is carried out with the highest degree of SAFETY.
This technique requires specialized training of the surgeon and the operative team.
Advantages
The advantages of this method include minimal physiological burden on the patient, early mobilization, and rapid recovery.
The patient is discharged the following day, able to tolerate light food, and must follow a specific diet for 30–40 days.
If desired, the patient may return to work promptly (3–5 days) and resume usual daily activities.
The patient’s symptoms typically resolve quickly, and progression of Barrett’s oesophagus to a potential oesophageal adenocarcinoma is prevented. (In such cases, ongoing follow-up by a gastroenterologist is essential.)
