Name of the Procedure:

Repair, Paraesophageal Hiatal Hernia (including Fundoplication), via Thoracoabdominal Incision, except Neonatal; without Implantation of Mesh or other Prosthesis

Summary

In layman's terms, this surgery fixes a hernia where part of the stomach pushes through the diaphragm into the chest. It often includes a fundoplication, which wraps a part of the stomach around the lower esophagus to prevent acid reflux. The surgery is done through an incision that goes across the chest and abdomen. No synthetic meshes or prosthetic materials are used in this repair.

Purpose

This procedure addresses paraesophageal hiatal hernias, where part of the stomach bulges through the diaphragm into the chest. The main goals are to relieve symptoms such as heartburn, chest pain, and difficulty swallowing and to prevent complications like strangulation of the stomach.

Indications

• Heartburn or acid reflux that does not respond to medication
• Chest pain or discomfort
• Difficulty swallowing (dysphagia)
• Risk of stomach strangulation or other complications from the hernia
• Large paraesophageal hernias detected via imaging

Preparation

• Fasting for 8-12 hours before the surgery
• Adjustments to medications as advised by the healthcare provider (e.g., stopping blood thinners)
• Pre-operative tests such as blood work, chest X-rays, ECG, and possibly an upper GI endoscopy

Procedure Description

1. Anesthesia: The patient is given general anesthesia.
2. Incision: A thoracoabdominal incision is made, crossing from the chest to the abdomen.
3. Isolation and Reduction: The stomach hernia is identified and gently moved back into its correct position within the abdominal cavity.
4. Fundoplication: Part of the stomach is wrapped around the lower esophagus to prevent acid reflux.
5. Hiatal Repair: The opening in the diaphragm (hiatus) is made smaller or reinforced.
6. Closure: The incision is closed with sutures or staples.

Duration

The procedure typically takes 2-4 hours.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Surgeons specializing in thoracic or gastrointestinal surgery
• Anesthesiologists
• Surgical nurses and operating room technicians

Risks and Complications

• Common risks: Pain, infection, bleeding, adverse reactions to anesthesia
• Rare risks: Esophageal or stomach injury, recurrence of the hernia, difficulty swallowing, long-term acid reflux

Benefits

• Relief from symptoms like heartburn, chest pain, and difficulty swallowing
• Reduced risk of serious complications from the hernia such as strangulation
• Improved quality of life

Recovery

• Hospital stay of 2-5 days post-surgery
• Pain management with prescribed medications
• Gradual reintroduction to soft foods, then normal diet over a few weeks
• Limited physical activity for 4-6 weeks
• Follow-up appointments to monitor recovery

Alternatives

• Medications: Proton pump inhibitors or H2 blockers to manage acid reflux symptoms
• Endoscopic procedures: Less invasive but may not be as effective for large hernias
• Watchful waiting: Monitoring the condition if symptoms are mild and manageable

Patient Experience

Patients will experience some discomfort and pain post-surgery, managed with medications. Initially, there will be dietary and activity restrictions. Most people can return to normal activities within 4-6 weeks. Pain management and adherence to post-operative care are crucial for a smooth recovery.