43334 Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; without implantation of mesh or other prosthesis

Name of the Procedure:

Repair of Paraesophageal Hiatal Hernia (including Fundoplication) via Thoracotomy, except Neonatal; without Implantation of Mesh or Other Prosthesis

Summary

This surgical procedure repairs a hiatal hernia where part of the stomach pushes through the diaphragm into the chest cavity. It involves fundoplication, which enhances the valve between the esophagus and stomach to prevent acid reflux. The surgery is performed through a thoracotomy, an incision between the ribs, without using mesh or other prosthetic materials.

Purpose

Medical Condition:

Paraesophageal Hiatal Hernia

Goals:

• Correct the hernia, preventing the stomach from protruding into the chest cavity.
• Alleviate symptoms such as chest pain, acid reflux, and swallowing difficulties.
• Reduce the risk of complications like strangulation or bleeding of the hernia.

Indications

• Severe or recurrent acid reflux not responsive to medication.
• Chest or abdominal pain.
• Difficulty swallowing or feeling of food being stuck in the esophagus.
• Risk of complications like strangulation of the hernia.

Preparation

• Fasting for at least 8 hours before surgery.
• Discussing medication adjustments with the healthcare provider.
• Preoperative tests such as blood work, chest X-ray, and esophageal manometry.

Procedure Description

• The patient is placed under general anesthesia.
• A thoracotomy incision is made in the chest to access the hernia.
• The stomach is repositioned back into the abdominal cavity.
• Fundoplication is performed by wrapping the top part of the stomach around the lower esophagus to strengthen the valve.
• The diaphragm is repaired where the hernia occurred.
• No mesh or prosthetic is used.
• The incision is closed with stitches or staples.

Duration

Typically takes 2 to 3 hours.

Setting

Performed in a hospital operating room.

Personnel

• Lead surgeon
• Surgical assistants
• Anesthesiologist
• Operating room nurses
• Surgical technologists

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs (esophagus, stomach, lungs)
• Difficulty swallowing
• Recurrence of the hernia
• Anesthesia-related complications

Benefits

• Relief from symptoms of acid reflux and chest pain.
• Prevention of hernia-related complications.
• Improved quality of life, usually noticed within a few weeks post-surgery.

Recovery

• Hospital stay of 3 to 5 days.
• Pain management with prescribed medications.
• Gradual return to normal activities over 4 to 6 weeks.
• Follow-up appointments to monitor recovery and healing.
• Dietary adjustments recommended, such as soft foods initially.

Alternatives

• Lifestyle changes and medications for managing symptoms.
• Other surgical approaches (e.g., laparoscopic repair with mesh) tailored to patient-specific needs.
• Pros of this procedure include a more direct repair without foreign materials; cons include longer recovery and more significant initial pain compared to minimally invasive methods.

Patient Experience

• Patients might feel discomfort or pain at the incision site.
• Pain managed through medications.
• Temporary restrictions on physical activity and diet modifications.
• Gradual improvement in symptoms and enhanced quality of life following recovery.