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«Heartburn is a common problem in the Western world. Approximately 7% of the population experiences symptoms of heartburn on a daily basis. «It is likely that there is abnormal esophageal exposure to gastric juice in 20-40% of this population, which means they have GERD.»
A hiatal hernia is a condition in which the upper portion of the stomach protrudes into the chest cavity through an opening in the diaphragm called the esophageal hiatus. This opening is usually large enough to allow passage of the esophagus. With progressive weakening and widening, this opening may allow upward passage or even entrapment of the upper part of the stomach above the diaphragm.
The presence of a hiatal hernia increases the risk of having GERD (Gastro Esophageal Reflux Disease), and when GERD is treated surgically, patients who have accompanying hiatal hernia also need surgical repair for this; that is why some patients and doctors use the term hiatal hernia to refer to GERD interchangeably, even though they are two distinct problems. BUT there are many patients with GERD who do not have hiatal hernia, and many patients with hiatal hernia who do not have GERD at all. That is why we decided to add this section to complement the GERD section.
A hiatal hernia is a common condition; by age 60, up to 60% of people have it to some degree.
CLASSIFICATION OF HIATAL HERNIAS AND INCIDENCE
Type I (90%): Classic sliding hiatus hernia in which the gastroesophageal junction (GEJ) migrates into the chest through the esophageal hiatus.
Type II (9%): true paraesophageal hernia, in which the fundus of the stomach herniates into the thorax and the EGUS is in a normal position.
Type III (1%): Combination of the two previous types.
SIGNS AND SYMPTOMS
Sliding hernia: most people have no symptoms. When it is present it is actually GERD giving its usual manifestations. Click here for more information on GERD and laparoscopic antireflux surgery.
Paraesophageal and mixed hiatal hernia: also often have no or minimal symptoms. When present, they may be the usual ones for GERD in addition to:
DIAGNOSIS
Usually the patient comes for consultation for symptoms related to hiatal hernia and the diagnosis is made with the same studies used for the diagnosis of gastroesophageal reflux, i.e. interrogation, endoscopy, manometry and pHmetry.
TREATMENT
Occasional or mild symptoms can usually be treated by non-surgical means, including lifestyle changes and over-the-counter medications.
When symptoms are frequent or intense, surgery is needed, the stomach is returned to the abdominal cavity and the hiatus is closed with sutures, however, Dr. Rosales uses a special mesh to reinforce the closure of the hiatus since recurrence rates are very high when a mesh is not used.
INDICATIONS FOR HIATAL HERNIA SURGERY
Since the presence of this defect itself is not an indication to correct it, the two main reasons to contact us for surgical treatment are:
Sliding hernia (type I) associated with severe GERD symptoms or complications related to this reflux.
Paraesophageal or mixed hernias (Type II or III), this type of hernias have a high morbidity and mortality when they are symptomatic and are not repaired surgically. Because of this, it is generally recommended that all people with these types of hernias undergo surgery regardless of the intensity of symptoms.
CONTRAINDICATIONS
Absolutes
Relative
ADVANTAGES OF LAPAROSCOPIC VS. OPEN HIATAL HERNIA SURGERY
RESULTS / COMPLICATIONS
The results of laparoscopic antireflux surgery are encouraging with low perioperative morbidity and mortality rates. The conversion rate from laparoscopic to open procedure is higher in inexperienced hands; the conversion rate in Dr. Rosales’ experience is less than 3%. Perioperative complications requiring reoperation, such as stomach migration or esophageal perforation, occur in less than 1%.
Overall symptom satisfaction rates after the procedure range from 90 to 100% and a significant improvement in quality of life a few weeks after the procedure.
SURGICAL TECHNIQUE (SIMPLIFIED EXPLANATION)
Under general anesthesia, a 5 mm abdominal incision is made in the left subcostal region (below the rib cage), CO2 is introduced into the abdominal cavity, then 4 more incisions are made in the abdomen (one of 10 mm and the rest of 5 mm) to introduce the rest of the instruments; The stomach hernia is returned to the abdominal cavity, the hernia sac is dissected and we proceed to close the hiatal defect with a biological mesh to reinforce the area. If GERD accompanies the hernia, we also perform an antireflux procedure (see Laparoscopic Antireflux Surgery). The incisions are closed with sutures and the procedure is completed.
Incisions for Laparoscopic Hiatal Hernia Surgery
Only if your Body Mass Index (BMI) is very high. Since the liver covers the stomach and the area to be worked on, dieting for a few days before the operation will help us and you by reducing the size of the liver, so the surgery will be easier and this will lead to a faster postoperative recovery.
Yes, only for a few days, and it varies according to the patient’s ability to adapt to the procedure. The reason is mainly to allow the body to get used to the intentional anatomical change made during surgery.
No, the only difference is that you’ll be free of expensive antacid medications and those pesky reflux symptoms.
Almost always, as it considerably reduces the risk of recurrence.
You will be discharged the following morning or a maximum of 48 hours after surgery, depending on the case.
Yes, but as mentioned, with the placement of the mesh it is significantly reduced.
Yes, but it is transitory, until your body adapts to the new position of the upper part of the stomach, and if the dysphagia continues, it can be easily treated.
I will be happy to assist you personally!
Emergency and consultation: 877-978-7437
Cell: 878-117-5271
Do not hesitate to send us your information, which will be kept confidential. We will be happy to help you.
info@drgabrielrosales.com
Rodrigo Andalón #112 Suite C Planta Baja
Colonia Burócratas,
Piedras Negras, Coahuila, México. 26020
PIEDRAS NEGRAS MEDICAL CENTER