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Hiatal hernia repair

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Illustrations

Hiatal hernia - X-ray
Hiatal hernia - X-ray
Hiatal hernia repair  - series
Hiatal hernia repair - series

Alternative Names    Return to top

Fundoplication; Anti-reflux surgery

Definition    Return to top

Hiatal hernia repair is surgery to correct a defect in the diaphragm, the breathing muscle that separates the chest area from the stomach area.

Description    Return to top

A hiatal hernia occurs when the normal opening in the diaphragm is too large. If the problem is not repaired, the stomach or other abdominal contents may bulge (herniate) into the chest, causing heartburn (acid reflux) and serious damage to the esophagus.

In some cases, a hiatal hernia can cause twisting of the intestines or stomach. This condition is called a voluvlus. It is a life-threatening emergency that requires immediate treatment.

For an open hiatal hernia repair, a cut is made in the stomach area (abdomen) while the patient is under general anesthesia (asleep, no pain). The surgeon tightens the hiatus. The upper part of the stomach (fundus) may be wrapped around the esophagus (fundoplication) to reduce heartburn due to acid reflux. Sometimes the surgeon will place a temporary tube from the stomach through the abdominal wall to keep the stomach in place.

In some patients, this operation can also be done with a laparoscope -- a method called "keyhole" or "telescopic" surgery. A laparoscope is a thin, hollow tube with a mini-camera on the end. Surgical tools can be sent through the laparoscope. Laparoscopic procedures use smaller cuts than open surgery, which results in less pain and scarring and shorter hospital stays.

A new procedure called endoluminal fundoplication uses a special scope (endoscope) to place small clips on the inside of the esophagus. The procedure is done to help prevent reflux.

Why the Procedure is Performed    Return to top

Hiatal hernia repair may be recommended when the patient has some of these symptoms:

Risks    Return to top

Risks specific to this surgery include:

Risks for any anesthesia include the following:

Risks for any surgery include the following:

Outlook (Prognosis)    Return to top

Hiatal hernia repair is a safe, effective operation. Reflux is greatly reduced or eliminated in 95% of patients.

Recovery    Return to top

Patients who have laparoscopic surgery typically spend 1 to 3 days in hospital. Those who have open surgery may spent 2 to 6 days in the hospital after the procedure.

During surgery, a tube was placed into the stomach through the nose and throat (nasogastric tube). Some surgeons like to leave the tube in for a few days after the procedure, while others do not.

Eat small, frequent meals after the surgery and avoid gas-producing foods.

Most patients go back to work in 2-3 weeks for laparoscopic surgery, or 4-6 weeks after open surgery.

Update Date: 7/7/2006

Updated by: J.A. Lee, M.D., Division of Surgery, UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network.

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