Name of the Procedure:

Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh

Summary

A laparoscopic repair of a paraesophageal hernia is a minimally invasive surgical procedure where small incisions are made in the abdomen to access and repair the hernia. This repair may also include a fundoplasty, which involves wrapping the stomach around the lower esophagus to strengthen the valve between the esophagus and stomach. In some cases, a mesh is implanted to provide additional support and prevent recurrence.

Purpose

This procedure addresses paraesophageal hernias, where part of the stomach pushes through the diaphragm next to the esophagus. The goals are to relieve symptoms, prevent complications like obstruction or strangulation of the herniated stomach, and reduce the risk of recurrence.

Indications

• Severe reflux or gastroesophageal reflux disease (GERD) symptoms unresponsive to medical treatment
• Symptoms of a hernia such as chest pain, difficulty swallowing, or vomiting
• Complications like stomach obstruction or strangulation
• Large or symptomatic paraesophageal hernias

Preparation

• Fasting for at least 8 hours before the procedure
• Adjustment or temporary discontinuation of certain medications, as advised by the doctor
• Preoperative diagnostic tests such as an upper gastrointestinal (GI) series, endoscopy, or manometry

Procedure Description

1. The patient is placed under general anesthesia.
2. Several small incisions are made in the abdomen.
3. A laparoscope (a small camera) is inserted through one of the incisions to provide a visual guide.
4. Specialized surgical instruments are inserted through the other incisions.
5. The hernia is reduced by pulling the stomach back into the abdomen.
6. The diaphragm opening is repaired, often with stitches, and a mesh is placed to reinforce the area.
7. A fundoplasty may be performed, wrapping part of the stomach around the lower esophagus to help prevent reflux.
8. The incisions are closed with sutures or staples.

Duration

Typically, the procedure lasts 2 to 3 hours.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon (typically a general or thoracic surgeon specialized in laparoscopic procedures)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common risks: infection, bleeding, or adverse reactions to anesthesia
• Rare risks: injury to surrounding organs (like the esophagus, stomach, or spleen), difficulty swallowing, gas bloat syndrome, and recurrence of the hernia
• Mesh-related complications: infection or erosion of the mesh

Benefits

• Relief from symptoms like heartburn, chest pain, and difficulty swallowing
• Reduced risk of serious complications like strangulation or obstruction
• Potential improvement in overall quality of life
• Many patients experience benefits within a few days to weeks post-procedure

Recovery

• Initial recovery in a post-anesthesia care unit (PACU) for monitoring
• Possible hospital stay of 1-2 days
• Gradual return to normal activities within 2-4 weeks
• Dietary modifications may be necessary initially (liquid or soft diet)
• Follow-up appointments to monitor healing and ensure there are no complications

Alternatives

• Watchful waiting for asymptomatic or minimally symptomatic hernias
• Medications to manage GERD symptoms (e.g., proton pump inhibitors)
• Lifestyle changes (e.g., dietary modifications, weight loss)
• Open surgical repair, which is more invasive and has a longer recovery time compared to laparoscopic repair

Patient Experience

• During the procedure: The patient will be under general anesthesia and will not feel any pain.
• After the procedure: Some discomfort and pain at incision sites, which can be managed with medications.
• Possible symptoms include temporary difficulty swallowing and bloating, and these typically subside over time.
• Frequent follow-up with the healthcare team to monitor recovery and address any concerns.