What Is Involved With Hiatal Hernia Surgery
Hiatal hernia is a condition caused by the protrusion of the stomach out of the esophageal opening in the diaphragm
. The viscera or the body cavity is divided into two distinct regions by a flat muscle known as the diaphragm which separates the chest cavity from the abdominal cavity that houses the digestive system along with the kidneys and liver etc.
The diaphragm has an opening to let the esophagus form a pathway for food to go to the stomach; however, sometimes this opening is naturally too large or it becomes enlarged due to certain factors; this in turn causes a condition known as hiatal hernia where the opening is big enough to let a portion of the stomach pass through it and get lodged in the chest cavity.
Mild cases of hiatal hernia can be treated with over the counter antacids, but in more severe cases surgical intervention is required. The hiatal hernia surgery is usually conducted in conjunction with another surgical procedure for treating a related ailment known as GERD or gastroesophageal reflux disease which is often caused due to a hiatal hernia.
The procedure:
Hiatal hernia surgery can be conducted in several ways - laparoscopic fundoplication, open surgery, endoscopic fundoplication, thoracotomy, laparotomy
Laparoscopic fundoplication: In this type of procedure small incisions are made on either side of the hernia; while a small camera known as a laparoscope is inserted into the viscera through one opening the others are used to insert special surgical instruments; the surgeon then conducts the procedure as the images from inside the chest cavity are displayed on a monitor.
If needed a tube is placed in the stomach to hold it in place. In some cases, the upper end of the stomach may be stapled to the esophagus to prevent it from going through the opening in the diaphragm. If this opening is too big, the surgeon may stitch it or use a mesh graft to reduce its size.
Open Surgery:
This procedure is usually conducted in people who have already had an abdominal surgery and hence a laparoscopic fundoplication will not be suitable. In this type of procedure the incision is bigger at almost 6 to 7 inches; if there is too much bleeding when conducting a laparoscopic procedure or if there is an accumulation of scar tissue from a previous procedure, the surgeon may take the call to conduct an open surgery.
Depending on the size of the hernia; the surgeon may only have to make a single incision to reach the chest cavity (thoracotomy) or the abdominal cavity (laparotomy).
Endoscopic fundoplication is a recently introduced procedure that is conducted by using a special camera known as an endoscope; it is attached to a tube that is passed through the mouth into the esophagus; then clips are placed on the diaphragm where the stomach and chest cavities meet to prevent stomach acids from flowing back.
Through all these procedures; the surgeons try to create pressure at the end of the esophagus which prevents the stomach acids and food from flowing back up.
Risks:
Like all other surgical procedures, hiatal hernia surgery is also prone to risks such as infection, excessive bleeding; risks arising from the use of anesthesia such as heart issues, pneumonia and respiratory problems and adverse reaction to certain drugs. However, some of the risks associated specifically with hiatal hernia surgery are:
* Bloating - this may cause flatulence and vomiting; the symptoms are usually experienced after meals and even though they subside in time, they can be quite annoying in the initial stages after the surgery
* Trouble and discomfort when swallowing; this usually subsides three months after the procedure
* Recurrence of the hernia
* Pulmonary complications including lung failure
* Damage to the organs in the digestive system such as the liver, stomach, intestines etc.
Post operative care:
Patients who have had a laparoscopic fundoplication need to spend one to three days in the hospital while those who have had an open surgery will need to stay at the hospital for 2 to 6 days. Avoid food items that may cause flatulence such as cauliflower and brocolli
You can go back to doing your regular activities one to two weeks after the procedure and can even return to work in 2 to 3 weeks. However, you must avoid physical strain and lifting heavy objects for at least three months.
Make sure that you keep your meals light a few days after the surgery; eat frequently but go for smaller portions.
by: Andrew Long
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