Hiatus Hernia

Hiatus Hernia

Introduction to Procedure

We know that undergoing any procedure is a scary experience.  We understand the worry and anxiousness that is associated with surgeries and procedures and aim to walk the road to recovery with you every step of the way. We put this information together using the very helpful handbook, ‘Handbook of Surgical Consent” from Rajesh Nair and David J. Holroyd.  We hope that the following information will answer all your questions and help you with the preparation phase for your procedure.

Description of procedure

Hiatus Hernia repair and Nissen Fundoplication

These procedures are used to repair a sliding hiatus hernia or to treat some forms of intractable gastro-oesophageal reflux disease. There are many different types of wrap described. Nissen’s is a 360˚ wrap of the fundus around the oesophagus. Prior to undergoing your procedure, various investigations need to be undertaken. Preoperative upper gastrointestinal endoscopy required to assess for oesophagitis or the presence of hiatus hernia.

Operative techniques

The procedure is most commonly performed laparoscopically.  The right and left crura are dissected and circumferential dissection of the oesophagus is performed.

The hiatus is then closed with sutures.  The short gastric vessels may be divided to improve mobilisation of the fundus.  In Nissen’s procedure the mobilised fundus is wrapped 360˚ around the oesophagus by passing it through the posterior window behind the oesophagus.  The wrap is then secured in place on the anterior oesophagus with a varying number of sutures.

Additional procedures that may become necessary
  • Conversion to open procedure.
Benefits
  • Therapeutic: Relieve symptoms and complications of reflux disease.
Alternative procedures/conservative measures
  • Conservative: Dietary management.
  • Medical: Proton-pump inhibitors, H2 receptor antagonists.
  • Surgical: Endoscopic anti-reflux procedures.
Serious/frequently occurring risks
  • Early: Postoperative dysphagia – normal for the first 6 weeks, but rarely permanent, pneumothorax, oesophageal perforation, gas bloat syndrome, epigastric pain, splenic or hepatic injury, iatrogenic vagotomy.
  • Late: Wrap failure, recurrence of symptoms, hiatal stenosis, ongoing dysphagia.
Blood transfusion necessary
  • Group and save: The process of determining the patient’s ABO blood group and screening serum for the presence of antibodies to common red cell antigens that can cause transfusion reactions.
Type of anaesthesia/sedation
  • General Anaesthesia.
Follow-up or need for further procedure
  • Special diet for 8 weeks postoperatively.
  • Follow-up Gastroscopy at 8 weeks after the surgery.
  • Revision surgery is rarely required for recurrence.
  • Routine outpatient review.

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