Published on 24 May 2010 | over 8 years ago

Do you have a question for the good Doctor?
Patient Education Company
Your doctor has recommended that you undergo surgery to repair a hiatal hernia. But what does that actually mean?

Your diaphragm is a muscle that separates your chest from you abdomen and helps you to breathe. Normally, the diaphragm has an opening for the esophagus to pass through where it connects with the stomach.

A hiatal hernia occurs when part of the stomach

pushes upward through this small opening.
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Your hiatal hernia may be causing considerable discomfort, with symptoms like heartburn, difficulty swallowing, chest pain and belching.

The reasons why hiatal hernias form are not known, but they are quite common. A Hernia is dangerous only if it becomes strangulated. That means that the portion of the stomach that has pushed up into the chest may become pinched - preventing blood from reaching it.

If this happens, you may require emergency surgery to restore blood flow and to repair hernia.

n the case of a hiatal hernia, there are no real alternatives to surgery.
Hernia's often remain stable and symptoms may be sometimes managed with medication and other therapies, but they never cure themselves.
And putting off surgery increases the risk of developing a strangulated hernia and even breathing problems.
Because of these risks, it's rare these days for a physician to recommend any treatment other than the surgical repair of a hiatal hernia.
Surgical procedures performed by making an incision large enough to expose the entire operative area
are called "open" procedures.
Your doctor believes that your medical condition and overall state of health make you a good candidate for less intrusive laparoscopic surgery.
A laparoscope is a narrow tube
that contains a light source
and a small video camera.
Using a laparoscope the surgeon is able to operate by making one or more very small incisions . . .Patient Education
through which the sterile laparoscope, and possibly other instruments, are inserted into the body. Using the laparoscope's video camera, the surgeon is able to explore and inspect the interior of the abdomen - often allowing the surgeon to see with greater detail and with more clarity than with the human eye alone.
However, it is important to understand that during the procedure, your surgical team is always prepared to convert a laparoscopic procedure to an open procedure - should they feel that your condition requires a more direct approach.
If the surgical team makes this decision, you will find upon waking up that your doctor has made a larger incision and that healing may proceed more slowly.
Converting to an open procedure will effect the length of your recovery and will probably require hospitalization. Of course, no surgery is completely risk free. But your physician believes that if you decide not to undergo the recommended procedure, you may be putting your health at risk.

After allowing a few minutes for the anesthetic to take effect ...
a small incision is made above the umbilicus;
then, a hollow needle will be inserted through the abdominal wall.
And the abdomen will be inflated with carbon dioxide.
An umbilical port is created for the laparoscope.
Four more incisions will be made, with care taken to keep the openings as small as possible. Patient Education
Once in place, the laparoscope will provide video images,
so the surgeon can insert the instruments used to locate and pull back the liver...
in order to see the upper part of the stomach.
First, the surgeon pulls the stomach away from the hiatus, or opening, in the diaphragm.
Then, the surgeon cuts away the tissue that connects the liver and the stomach.
The surgeon can then dissect part of the diaphragm around the esophagus... This gives better access to the diaphragm and the esophagus.
Next, the surgeon pulls the esophagus upwards...
and closes the hiatus with sutures.
Some hiatal hernias can cause persistent and painful acid reflux and your doctor may decide to correct the problem surgically. In this case, the surgeon divides and separate the arteries that supply blood to the top of the stomach.
After freeing the stomach from the spleen,
your doctor wraps the upper portion of the stomach around the esophagus and sutures it into place. Patient Education
A rubber tube is placed in the esophagus to keep the wrap from becoming too tight.
All of the instruments are withdrawn...
the carbon dioxide is allowed to escape...
the muscle layers and other tissues are sewn together and the skin is closed with sutures or staples.
Finally, sterile dressings are applied.
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Hiatal hernia surgery only rarely leads to complications.
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