43335 Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; with implantation of mesh or other prosthesis

Name of the Procedure:

Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; with implantation of mesh or other prosthesis.

Summary

This surgical procedure involves the repair of a paraesophageal hiatal hernia through thoracotomy, along with performing a fundoplication and the placement of a mesh or other prosthetic material. A thoracotomy is an incision into the chest wall to access the affected area.

Purpose

The procedure aims to correct a paraesophageal hiatal hernia, a condition in which a part of the stomach pushes through the diaphragm into the chest cavity. The expected outcomes include alleviating symptoms such as pain and gastroesophageal reflux, preventing potential complications such as strangulation of the hernia, and improving the patient's quality of life.

Indications

• Chronic or severe gastroesophageal reflux disease (GERD)
• Upper abdominal or chest pain
• Difficulty swallowing (dysphagia)
• Recurrent aspiration pneumonia
• Structural complications causing strangulation or obstruction of the hernia

Preparation

• Fasting for at least 8 hours before the surgery
• Discontinuation of certain medications as advised by the healthcare provider
• Blood tests, imaging studies (e.g., X-ray, CT scan), and an endoscopy
• Evaluation of overall fitness for surgery, including heart and lung function tests

Procedure Description

1. The patient receives general anesthesia for a pain-free experience.
2. A thoracotomy is performed, creating an incision on the side of the chest.
3. The surgeon retracts the lung and identifies the herniated stomach.
4. The hernia is reduced, and the stomach is repositioned in the abdominal cavity.
5. Fundoplication is conducted by wrapping the top part of the stomach around the lower esophagus to prevent reflux.
6. A mesh or prosthesis is implanted to reinforce the diaphragm and prevent recurrence.
7. The incision is closed, and the patient is taken to the recovery area.

Duration

The procedure typically takes 3-4 hours, depending on the complexity.

Setting

The procedure is performed in a hospital operating room.

Personnel

• General or thoracic surgeon
• Surgical nurses
• Anesthesiologists
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Adverse reactions to anesthesia
• Damage to nearby organs (e.g., lung, spleen, esophagus)
• Recurrent hernia
• Difficulty swallowing (dysphagia) post-surgery

Benefits

• Relief from symptoms such as pain and acid reflux
• Reduced risk of serious complications such as strangulation of the hernia
• Improved ability to eat and swallow
• Enhanced overall quality of life

Recovery

• Hospital stay for 2-5 days post-surgery
• Gradual reintroduction of diet, starting with liquids
• Pain management with medications
• Avoid heavy lifting or strenuous activities for at least 6 weeks
• Follow-up appointments to monitor recovery and ensure no recurrence of the hernia

Alternatives

• Medications to manage symptoms of GERD
• Lifestyle changes, such as dietary modifications and weight loss
• Less invasive procedures such as laparoscopic surgery
• The pros and cons include varying degrees of effectiveness and recovery times.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-procedure, discomfort and pain are managed with medications. The patient may experience soreness at the incision site and some difficulty swallowing temporarily. Comfort measures, including pain relief and support from medical staff, are provided to facilitate a smoother recovery.