Hiatal Hernia Repair
Hernia is an opening formed by the lining of the abdominal cavity. Abdominal wall hernia occurs when the contents of the intestine bulges out of the abdominal wall. Hernias are developed at birth (congenital) or may appear later (acquired).
Hernia may be present at birth and occurs when the lining around the abdominal organs fails to close before birth. Hernia may also result if the connective tissue degenerates in the abdominal wall due to which pressure builds up in the abdominal wall leading to a bulge in the abdomen. Some of the other factors that worsen hernia are chronic cough, obesity, constipation, pregnancy, poor nutrition, smoking and stretching or straining abdominal muscles while lifting heavy objects.
Hiatus hernia
Normally, the stomach is completely below the diaphragm. In individuals with hiatus hernia, part of the stomach slides through the diaphragm, the muscular sheet that separates the lungs and chest from the abdomen and protrudes into the chest cavity. Hiatal hernia is more common and affects people of all ages.
Hiatal hernias are of two types:
- Sliding hiatal hernia: - The top portion of the stomach slides up and down through the diaphragm with increased pressure on the abdominal cavity
- Fixed hiatal hernia: -The top portion of the stomach moves up into the chest cavity and does not slide down into normal position.
Obesity, chronic cough, chronic constipation, smoking, and hereditary factors increase the risk of developing hiatal hernias. Hiatal hernia may not cause any symptoms, but patients may experience chest pain, heart burn, belching, and hiccups.
Your doctor can confirm the presence of hernia by performing a physical examination. A special X-ray (using a barium swallow) will be ordered that allows your doctor to view the oesophagus or by performing endoscopy.
Treatment
Surgery is the only treatment and is usually performed for hiatal hernias that enlarge in size due to increased intra-abdominal pressure causing intestinal obstruction and restricted blood supply which may lead to death of bowel tissues.
A hiatal hernia repair is usually performed as an outpatient surgery with no overnight stay in the hospital. The operation may be performed as an 'open' or 'keyhole' (laparoscopic) surgery. Your surgeon will decide which procedure is suitable for the repair and performs with your consent.
Laparoscopic or Keyhole surgery
Laparoscopic surgery is performed in a hospital operating room under general anaesthesia. The television camera attached to the laparoscope displays the image of the abdominal cavity on a television screen. The surgeon makes several small incisions over the abdomen to insert the balloon dissector and trocars (keyholes). A deflated balloon along with the laparoscope is inserted and the balloon is inflated with a hand pump under direct vision. Once the trocars (key holes) are placed, the keyhole instruments are then inserted to repair the hernia. After completion of the repair, the CO2 gas is evacuated, and the trocars are removed, and the tiny incisions are closed and dressed in a sterile bandage.
As common with other surgeries, hernia surgery is also associated with certain complications such as local discomfort and stiffness, infection, damage to nerves and blood vessels, bruising, blood clots, wound irritation and urinary retention.