43281 Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh

Name of the Procedure:

Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh. Commonly known as laparoscopic paraesophageal hernia repair.

Summary

This minimally invasive surgery repairs a paraesophageal hernia, where part of the stomach pushes up through the diaphragm next to the esophagus. The surgery also typically involves a fundoplasty, which is wrapping the top part of the stomach around the esophagus to prevent reflux, but it does not include the use of mesh.

Purpose

The procedure addresses a paraesophageal hernia, a condition where the stomach bulges into the chest area through an opening in the diaphragm. The goals are to reposition the stomach, reduce or eliminate symptoms like acid reflux and difficulty swallowing, and prevent complications like strangulation of the stomach.

Indications

• Symptoms of acid reflux or GERD (gastroesophageal reflux disease)
• Difficulty swallowing (dysphagia)
• Chest pain
• Anemia or gastrointestinal bleeding
• Shortness of breath

Preparation

• Fasting for at least 8 hours before surgery.
• Adjustments to medications, especially blood thinners.
• Diagnostic tests such as upper GI series, endoscopy, and esophageal manometry.

Procedure Description

1. Anesthesia: The patient is given general anesthesia to ensure they are asleep and pain-free.
2. Incision: Small incisions are made in the abdomen.
3. Insertion of Instruments: A laparoscope (a thin tube with a camera) and other surgical instruments are inserted through these incisions.
4. Reduction of Hernia: The stomach is gently pulled back into the abdominal cavity.
5. Repair: Sutures are used to close the opening in the diaphragm.
6. Fundoplasty: The upper part of the stomach is wrapped around the esophagus to help prevent acid reflux.
7. Closure: The incisions are closed with sutures or surgical glue.

Duration

Typically, the procedure takes about 2 to 3 hours.

Setting

The procedure is usually performed in a hospital operating room.

Personnel

• General Surgeon or Thoracic Surgeon
• Anesthesiologist
• Surgical Nurses
• Possibly a Surgical Assistant

Risks and Complications

• Common risks: Infection, bleeding, and adverse reactions to anesthesia.
• Rare risks: Damage to surrounding organs, recurrence of the hernia, difficulty swallowing, gas bloat syndrome.

Benefits

• Relief from symptoms like acid reflux and chest pain.
• Reduced risk of serious complications such as stomach strangulation.
• Improved quality of life and ability to eat and breathe comfortably.

Recovery

• Hospital stay: Typically 1-2 days.
• Activity: Limited physical activity for about 2 weeks.
• Diet: Gradual return to normal diet, starting with liquids and soft foods.
• Follow-up: Regular follow-up appointments to monitor recovery and address any issues.

Alternatives

• Watchful waiting with lifestyle modifications and medications for mild symptoms.
• Open surgical repair, which is more invasive with longer recovery times.
• Endoscopic procedures that may be less invasive but are not suitable for all patients.

Patient Experience

• During the procedure: Patients will be under general anesthesia and will not feel pain.
• After the procedure: Some discomfort, bloating, and mild pain which can be managed with pain medications.
• Post-operative instructions will include care of incisions, activity restrictions, and diet guidelines.

Pain and discomfort are typically managed with prescribed pain relievers and patients will be guided on how to ease back into their daily routines.