Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; without implantation of mesh or other prosthesis
CPT4 code
Name of the Procedure:
Repair of Paraesophageal Hiatal Hernia (Including Fundoplication) via Laparotomy, Except Neonatal; Without Implantation of Mesh or Other Prosthesis
Summary
In this procedure, a surgeon corrects a paraesophageal hiatal hernia through an open abdominal incision (laparotomy). The stomach is repositioned, and the hiatus (opening in the diaphragm) is tightened. Additionally, a fundoplication is performed to prevent acid reflux by wrapping the upper part of the stomach around the lower esophagus.
Purpose
The procedure addresses paraesophageal hiatal hernia, where part of the stomach pushes through the diaphragm next to the esophagus. Goals include repositioning the stomach, preventing further herniation, and reducing symptoms like acid reflux and difficulty swallowing.
Indications
- Persistent acid reflux or gastroesophageal reflux disease (GERD)
- Difficulty swallowing (dysphagia)
- Chest pain or discomfort
- Risk of stomach strangulation from the hernia
- Recurrent vomiting
Preparation
- Fasting for 8-12 hours before surgery
- Adjustments or discontinuation of certain medications as advised by the doctor
- Preoperative diagnostic tests, such as blood tests, imaging studies (X-ray, CT scan), and endoscopy
Procedure Description
- Anesthesia: The patient receives general anesthesia.
- Incision: A surgeon makes an open abdominal incision (laparotomy).
- Repositioning: The stomach is carefully pulled back into the abdominal cavity.
- Hiatus Repair: The diaphragm hiatus is tightened to prevent future herniation.
- Fundoplication: The surgeon wraps the upper part of the stomach (fundus) around the lower esophagus to reinforce the valve between the esophagus and stomach.
- Closure: The incision is closed with sutures or staples.
Duration
The procedure typically lasts 2-3 hours.
Setting
Performed in a hospital operating room.
Personnel
- Surgeon
- Surgical nurses
- Anesthesiologist
Risks and Complications
- Infection at the incision site
- Bleeding
- Recurrent hernia
- Difficulty swallowing (dysphagia)
- Injury to nearby organs (e.g., esophagus, stomach, spleen)
- Complications from anesthesia
Benefits
- Relief from acid reflux and GERD symptoms
- Prevention of future herniation
- Improved quality of life and reduced risk of complications related to the hernia
Recovery
- Hospital stay of 2-5 days post-procedure
- Instructions to avoid heavy lifting and strenuous activities for several weeks
- Pain management with prescribed medications
- Follow-up appointments for monitoring and suture removal
Alternatives
- Lifestyle modifications: Dietary changes, weight loss, and head-of-bed elevation
- Medications: Antacids, H2 blockers, and proton pump inhibitors (PPIs) to manage reflux symptoms
- Less invasive surgeries: Laparoscopic repair, which involves smaller incisions
Patient Experience
During the procedure, the patient is under general anesthesia and will not feel pain. Postoperatively, there may be pain at the incision site, which is managed with medications. Patients may experience some difficulty swallowing initially, but this usually improves over time. Adhering to post-surgery instructions and attending follow-up appointments are essential for a smooth recovery.