Hiatal Hernia Repair

Hiatal hernia occurs when part of the stomach and sometimes other organs of the abdominal cavity slide upward through an opening in the diaphragm into the chest cavity. Normally, the opening in the diaphragm only contains the lower part of the esophagus. When the muscle of the diaphragm weakens, the opening becomes large enough to allow the stomach to slide up into the chest cavity. This results in symptoms of heartburn, regurgitation, difficulty swallowing, or chest pain. With time, and if left untreated, constant exposure of the esophagus to stomach acids may cause chronic inflammation (esophagitis), ulcers, and scarring of the esophagus. When conservative measures fails to control the symptoms, surgery for hiatal hernia repair is recommended. The surgeon pulls the hernia contents back into the abdominal cavity, excises the hernia sac, reinforces the opening in the diaphragm with sutures, and sometimes also performs fundoplication. In fundoplication, the top portion of the stomach (fundus) is wrapped around the esophagus to create a pressure area and prevent the contents of the stomach from backing up into the esophagus (acid reflux). The surgery can be performed using an open approach, where the repair of the hernia is done through a single large incision on the abdomen or the left side of the chest. Alternately, laparoscopic approach can be used, where a surgeon makes several smaller incisions on the abdomen to introduce a video camera (laparoscope) and a number of instruments to perform the repair. Laparoscopic method, also known as minimally invasive, results in reduced post-operative pain, faster healing, and lesser scarring.