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Hiatal Hernia and Gastroesophageal Reflux Repair by Laparoscopy

A hiatal hernia is a condition in which part of the stomach sticks upward into the chest through an opening in the diaphragm (the layer of muscle, used in breathing that separates the thorax from the abdomen). This is generally associated with gastroesophageal reflux disease, which occurs when excess stomach acid flows up into the oesophagus and leads to burping, regurgitation of food, indigestion, difficulty swallowing, nausea and vomiting, sometimes with blood, throat irritation, snoring, changes of voice and cough.

A change of lifestyle (weight loss, cutting down or stopping smoking and alcohol consumption, different eating and sleeping habits) may reduce the severity of the symptoms.  Some kind of drug therapy may be required (antacids and over-the-counter drugs).  However, is the symptoms persist, the patient must either learn to live with the condition or undergo surgery.

Laparoscopic hiatal hernia and gastroesophageal reflux repair is a guaranteed solution to these problems, which involves surgical construction of an anatomic valve with minimum pain, quicker recovery and better aesthetic results.

Benefits of the Operation

Because only very small incisions are made and no muscles or aponeuroses are cut, any pain is minor. This allows patients to get moving more quickly, it improves their general condition and mood, prevents thrombosis and embolisms, respiratory drive is better, preventing pneumonia and respiratory complications, etc. All this leads to a quicker recovery. Because the incisions are smaller, there is practically no risk of infection and any eventrations in the surgical wound disappear. The patient can also start eating earlier and tolerates food better.

Medical-technical description

Laparoscopic repair of the hiatal hernia and gastroesophageal reflux consists of surgical construction of a valve on the lower oesophageal sphincter by wrapping the stomach around the oesophagus without opening the abdomen, working through five small orifices (three measuring 5 mm and two measuring 10 mm), through which a camera and the instruments for dissection, cutting and suturing are inserted.  This requires a high level of specialisation and technology.

About the operation

The surgery, which takes around an hour, is performed under general anaesthesia and consists of the insertion of a cannula or tube into the abdomen.

A laparoscope (a tiny telescope) connected to a special camera, is inserted through the cannula, and gives the surgeon a magnified view of the patient's internal organs on a television screen. The surgeon works while looking at the monitor. Other cannulas are inserted to allow the surgeon to carefully separate the hiatus hernia from the surrounding organs, dissect the oesophagus and stomach and wrap the stomach around the lower oesophageal sphincter to build a pressure valve.

Before the operation

  • You will have a blood test, medical examination, chest X-ray and electrocardiogram.
  • Your groin area will be shaved.
  • You must not eat or drink for 6 hours before your operation.
  • You must stop taking drugs such as aspirin, anticoagulants, anti-inflammatory agents and vitamin E, one week before the surgery.
  • You must remove all metal objects during the operation (rings, bracelets, earrings, body piercings, etc).

Post-operative care

  • Once you can tolerate food you will be released from hospital, on the same day or on the day following the surgery.
  • You will be able to walk the following day, and a few days later you will be able to lead a completely normal life.
  • You can remove the dressings and bathe the day after surgery.
  • After one week you will be able to go back to normal daily life, driving, climbing stairs, lifting light objects and working.

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