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Hiatal hernia repair - series

 

Normal anatomy

The esophagus runs through the diaphragm to the stomach. It functions to carry food from the mouth to the stomach.The esophagus passes through the diaphragm just before it meets the stomach, through an opening called the esophageal hiatus.

Normal anatomy
Indications

When the opening (hiatus) in the muscle between the abdomen and chest (diaphragm) is too large, some of the stomach can slip up into the chest cavity. This can cause heartburn (gastro-esophageal reflux: GER) as gastric acid backflows from the stomach into the esophagus. Hiatal hernia repair is surgery to repair a bulging of stomach tissue through the muscle between the abdomen and chest (diaphragm) into the chest (hiatal hernia).

Hiatal hernia repair may be recommended when the patient has:

  • severe heartburn
  • severe inflammation of the esophagus from the backflow of gastric fluid (reflux)
  • narrowing of the opening (hiatus) through the diaphragm (esophageal stricture)
  • chronic inflammation of the lungs (pneumonia) from frequent breathing in (aspiration) of gastric fluids
Indications
Incision

While the patient is deep asleep and pain-free (general anesthesia), an incision is made in the abdomen.

Incision
Procedure

The stomach and lower esophagus are placed back into the abdominal cavity. The opening in the diaphragm (hiatus) is tightened and the stomach is stitched in position to prevent reflux. The upper part of the stomach (fundus) may be wrapped around the esophagus (fundoplication) to reduce reflux.

Procedure
Aftercare

Patients may need to spend 3 to 10 days in the hospital after surgery. A tube will be placed into the stomach through the nose and throat (nasogastric tube) during surgery and may remain for a few days. Small, frequent feedings are recommended.

Aftercare

Review Date: 8/1/2009
Reviewed By: Reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program San Diego, California.
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