Saturday, April 13, 2024

Is Hiatal Hernia Surgery Worth It

How Do I Get Ready For A Hiatal Hernia Repair

Can surgery fix a hiatal hernia?

Your healthcare provider will explain the surgery to you. Be sure to ask any questions you may have.

Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines such as ibuprofen. It also includes vitamins, herbs, and other supplements.

You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully and ask questions if something is not clear.

Your healthcare provider will ask questions about your past health. He or she may also do a physical exam. This is to be sure you are in good health before having the surgery. You may also have blood tests or other tests.

Tell your healthcare provider if you:

  • Are pregnant or think you may be.
  • Are sensitive or allergic to any medicines, iodine, latex, tape, or anesthesia drugs .
  • Have a history of bleeding disorders or are taking any blood-thinning medicines, aspirin, or other medicines that affect blood clotting. You may have to stop taking these medicines before your surgery.

You must not eat or drink anything for 8 hours before the surgery. This often means no food or drink after midnight.

Your healthcare provider may have other instructions for you based on your medical condition.

Laparoscopic Hiatal Hernia Repair:

If you remember only one thing about this post, make sure you remember what Im about to say now In the 21 st Century 99.9% of these surgeries can be done laparoscopically or minimally invasive.

Laparoscopic surgery gives you many advantages over the open approach. Including less pain, faster recovery, faster return to your activities, fewer chances of wound complications like hernias or infections.

Having said that, not every surgeon that can do laparoscopic cases can do a good hiatal hernia repair or anti-reflux surgery. For this surgeries experience and skills matter. You want a surgeon that has done many of these cases, a surgeon that does a lot of complex laparoscopic surgeries with excellent outcomes.

Before you undergo surgery in my practice you will need several studies, some I mentioned above. At the minimum, you will undergo an Upper GI series and Endoscopy. Depending on those results you might also need an esophageal manometry and pH study .

You will have 5 small incisions, the largest is 12 mm in size , the others are 5 mm in size. The surgery takes on average 60 to 120 minutes depending on the size of the hernia and your prior surgical history. It is done under general anesthesia. Surgery usually has two parts.

The first part is the hernia repair were the stomach is pulled back down in the abdomen, the hernia sac is removed and the diaphragmatic hiatus is closed to its normal size with sutures and in some cases with an absorbable mesh .

What Happens During A Hiatal Hernia Repair

Your healthcare provider will decide if you should have a laparoscopic surgery or an open repair. Laparoscopic surgery has smaller incisions and a shorter recovery time.

A hiatal hernia repair is often done while you are asleep under general anesthesia. Your healthcare provider will decide what kind of anesthesia to use . This will depend on the reason for the surgery and your overall health.

Ask your healthcare provider about the details of your surgery. In general, you can expect that:

  • You will be asked to take off any jewelry or other items that may be in the way during surgery.
  • You will be asked to take off your clothes and wear a hospital gown.
  • An IV line will be inserted in your arm or hand.
  • A thin tube may be put into your bladder. This will help you to urinate safely during surgery.
  • You will be placed on your back on the operating table.
  • The anesthesiologist will keep checking your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
  • If you have too much hair at the surgical site, it may be taken off.
  • The skin at the surgical site will be cleaned with an antiseptic solution.
  • For a laparoscopic hiatal hernia repair, your healthcare provider will make small incisions in your belly. Carbon dioxide gas will be put into your belly to make it swell. This helps your healthcare provider see your organs more clearly. Then he or she will insert a tube that has a camera and surgical tools, to close the hernia.

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    What Is The Best Diet For A Hiatal Hernia

    The best way to deal with acid reflux symptoms caused by a hiatal hernia is to reduce the portion sizes of your meals. Remember that symptoms of reflux intensify when the stomach becomes too full, which forces acid up into the esophagus.

    Furthermore, you should limit or reduce how often you eat foods that trigger heartburn or acid reflux symptoms. This includes avoiding foods like chocolate, fried foods, high-fat foods, spicy foods, alcohol, dairy, and citrus fruits that are high in acid.

    Causes and Risk Factors for Hiatal Hernias

    Age and obesity are the two most common risk factors for developing a hiatus hernia. As for causes, the stress placed on the diaphragm or surrounding muscles can increase the risk of developing a hernia.

    Can a hiatal hernia be caused by lifting heavy objects?

    Yes. Additionally, intense coughing, straining bowel movements, heavy vomiting and even exercise can cause stress that widens the hiatus and increases the risk of developing a hernia.

    Hiatal Hernia Surgery Cost

    Medical ilustration of a hiatal hernia in the upper part of the stomach ...

    A hiatal hernia is a condition wherein the stomach will extend up through the diaphragm and into the chest, often causing either severe acid reflux or GERD symptoms. While these symptoms can often be remedied via medications, for some, surgery may be the only option.

    The surgical process is designed to help pull your stomach back into the abdomen, making the opening in the diaphragm smaller, and depending on your circumstances, the surgery may also reconstruct the esophageal sphincter or remove the hernial sacs.

    Not recommended for everyone, theres a good chance your doctor will only recommend it as a last resort after you tried all other treatment options.

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    When Do You Need Surgery For A Hernia

    In some cases, if the hernia is small, doesnt grow and doesnt cause any pain or problems, then surgery may not be needed immediately. However, its important to realize that most of the time, hernias do get larger. While it may not be causing trouble now, it is very likely that it could lead to more serious complications later if it is not repaired.

    One of those complications is strangulation. This occurs when the bulging tissue is squeezed by the muscle wall. As a result, the blood supply is cut off and the tissue begins to die.

    Symptoms include:

    • Intensifying pain
    • A bulge that turns red or purple

    Because of the potentially serious complications, we generally recommend that those with a hernia undergo a simple procedure to ensure that it does not increase in size or grow worse.

    Ask The Doctors: Hiatal Hernias

    A hernia occurs when part of an internal organ or tissue pushes through a weak spot in your muscle. Most hernias happen when the intestines bulge through a tear in the abdominal wall. Hernias are very common and are usually treated with surgery. The Food and Drug Administration estimates that about one million hernia repairs are performed each year in the United States.

    While most hernias occur when the intestines push through the abdominal wall and cause a visible lump and pain in the affected area, some hernias are different.

    A hiatal hernia is a different kind of hernia that affects the diaphragm and might not show any symptoms for some people. Washington University cardiothoracic surgeon Shuddhadeb Ray, MD, MPHS, sees a large number of hiatal hernia patients at Christian Hospital in North St. Louis. An expert in minimally invasive surgery for hernia repair, Ray answers some frequently asked questions about hiatal hernias.

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    Combating Hiatal Hernia Recurrence

    Miguel A. Burch, MD

    Hiatal hernias recur after surgery 15% to 50% of the time, says Miguel Burch, MD, chief of Minimally Invasive and GI Surgery at Cedars-Sinai. Though some patients are asymptomatic upon recurrence, others experience a return in symptoms such as reflux, regurgitation or the sensation of waking up during the night choking.

    To figure out what might cause or prevent a recurrence, Burch and a team of researchers launched a study to review the short- and long-term outcomes in patients who have undergone a Collis gastroplasty with fundoplication and hiatal hernia repair. The study included 183 patients who had undergone these procedures and were cared for by four surgeons at Cedars-Sinai between 2002 and 2018.

    “We looked at a database of patients who had these procedures and interviewed those who had a Collis gastroplasty,” says Burch. “Then we presented them with a validated questionnaire to determine the impact of their treatment.”

    Esophageal length is key to the success of hiatal hernia repair, because when too short, it can act as a rubber bandpulling the stomach back up into the chest, promoting recurrence. The team’s research helped them identify factors that can cause a shortened esophagus, illuminating a path toward longer-term success after repairs.

    Hiatal Hernia Surgery: Missing The Root Cause

    Repairing a Hernia with Surgery

    I just want to share this with you: do your due diligence on the outcomes of surgeries. Remember: a successful surgery just means that the procedure the surgeon tried to do, he/she successfully did. That doesnt mean success in the way a patient would want success, meaning this is never going to bother me again.

    Why is it that theres such poor outcome for hiatal hernia surgery? Lets look at that.

    Remember that were talking small hiatal hernia: the opening has just expanded a little bit because the stomach is pushing up. The surgeon goes in there and sews that closed.

    This one young man, this 10-year-old Im talking about, for various reasons, he vomited a lot. Its something his body kind of regularly does as soon as he doesnt feel comfortable. Imagine doing that to him and sewing this so tight that he literally could never vomit again as long as he lived it.

    It can be a little scary if you really feel the need. It can be quite miserable. And weve spoken to patients who have gone through that.

    More importantly, the fact is that the hiatal hernia surgery closed that widened opening. Theyve stitched that closed or tighter where it should be, so just the esophagus is passing through, and now the stomach is nicely below the diaphragm.

    But remember: whats the root cause? What caused that stomach to spasm and push up?

    Getting in there and sewing that widened opening more narrow is not getting to the reason why the stomach is in spasm.

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    What Can Be Mistaken For A Hernia

    . Hernias can go misdiagnosed in women, and can instead be thought to be ovarian cysts, fibroids, endometriosis, or other abdominal issues, according to the SLS. Womens hernias can be small and internal. They might not be a bulge that can be felt in an exam or be visible outside the body, according to the SLS.

    Hiatal Hernia Surgery: Not For Everyone

    Surgery is always a dangerous proposition, going under anesthesia always a dangerous proposition. Its certainly not anything to take lightly.

    The reason I wanted to mention it today is because two days ago, I spoke to a mother with a 10-year-old. This young man is 10 and he has a small hiatal hernia, and they were actually sent to a surgeon who is recommending surgery on a 10-year-old.

    This is really a dangerous precedent.

    All I can think is that with the increased discussion of hiatal hernia, more people are wondering if they have it, theyre being educated, which is the whole point of this channel.

    The whole point is to increase the knowledge of what this is, because so many are suffering from it, and they have no idea why theyre told its all in their head.

    But getting back to this young man being recommended surgery, considering its poor outcome, it just doesnt make any sense.

    The only thing my team and I can come up with is more discussion and helping to contribute to it, so that theres more awareness.

    Patients are going to their gastroenterologist, asking Do I have a hiatal hernia?. And because they dont have any tools other than antacids, theyre resorting more to hiatal hernia surgery which is scary.

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    A New Technique For Treatment

    Edward H. Phillips, MD

    Before operating, surgeons always work with gastroenterologists to exclude, or heal if present, esophagitis or esophageal ulcers, which are common causes of a shortened esophagus. And, for times when a more significant intervention is needed, the Cedars-Sinai team has developed a new methodology that re-creates a lengthier esophagus using a small part of the stomach.

    “Using robotic and minimally invasive techniques, the upper stomach is shaped into a tubular structure that performs as if it were an esophagus and allows the stomach and fundoplication to remain below the diaphragm. This intervention reduces the risk the hernia will recur,” says Burch.

    The increased implementation of Collis gastroplasty originated from Edward Phillips, MD, the Dolly Parton Chair in Surgical Innovation, executive vice chair of the Department of Surgery at Cedars-Sinai and a world-renowned pioneer of laparoscopic and foregut surgery. Phillips first noted the excellent outcomes patients were experiencing with this advanced technique.

    This procedure eliminates the “rubber band effect” to a large degree and has resulted in overwhelming patient satisfaction86.6% of patients in the study reported a satisfaction score of 8 or more out of 10 after one year. The published results indicate “patients requiring Collis gastroplasty can expect significant long-lasting reductions in heartburn, regurgitation, dysphagia, antacid medications and hiatal hernia recurrence.”

    Linx Surgery Brings Success

    39 best Hiatal Hernia And Complications From !! images on Pinterest ...

    The LINX approach is an innovative surgery that can relieve the symptoms of GERD caused by a hiatal hernia. During this procedure, your doctor inserts a small, flexible ring made of magnetic beads around the esophagus, just above the stomach.

    The ring strengthens the sphincter and prevents reflux, but it doesnt prevent normal bodily functions like relieving gas by burping.

    If you have a hiatal hernia and the LINX is recommended, our team repairs the hernia before implanting the ring. The advanced device is designed to last a lifetime.

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    Washington University Hiatal Hernia Surgeons

    Washington University hernia surgeons see patients at the Center for Advanced Medicine, Barnes-Jewish West County Hospital and Christian Hospital.

    Minimally invasive and cardiothoracic surgeons provide expert laparoscopic surgical care for patients with hiatal hernias and GERD.

    For more information about hernia surgery, or hernia patient appointments at the Center for Advanced Medicine or Barnes-Jewish West County Hospital, please call 314-454-8877.

    For more information about Christian Hospital, or to schedule an appointment with Dr. Ray, visit the Christian Hospital website or call 314-747-9355.

    Assessing The Risk For Elective Surgery

    Despite the low modern rates of morbidity and mortality, surgical intervention is not without complications. PEH surgery complications can include visceral injury, vagal nerve injury, pneumothorax, and mediastinal hemorrhage, among others . When considering the routine repair of an asymptomatic hernia, it is important to identify important risk factors of the patient. This is both for optimization and for the informed consent discussion.

    As was previously mentioned, Jassim et al. found that overall risk of complication during and following elective and non-elective PEH repair was associated with chronic lung disease, electrolyte disorders, and weight loss/malnutrition. Lower rates of complication were significantly associated with female sex, elective and laparoscopic procedures . Increasing age was also associated with an increased overall risk of complication and mortality following elective and non-elective PEH repair.

    Augustin et al. found an inverse relationship between BMI and mortality. Their study found that BMI 25-50 and BMI 30 were significantly protective of mortality . Frailty and preoperative sepsis increased the odds of mortality.

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    Is Hiatal Hernia Surgery Needed Unlikely

    Is hiatal hernia surgery necessary in most cases? . How do we treat Hiatal Hernia Syndrome naturally? What can you expect during the treatment program created by Root Cause Medical Clinic? Can you do anything about your hiatal hernia if you cant be treated at our medical clinics? .

    Dr. Rupa Chakravarty, Doctor of Physical Therapy, discusses the topic. Watch this interesting video.

    Complications After Hiatal Hernia Surgery

    Q& A – Hiatal Hernia Diagnosis

    Potential problems, as per the University of North Carolina Department of Surgery, could include minimal pain after the surgery, such as a sore abdomen and/or near the incision sites, but this often subsides a few days after and will disappear on its own. In the meantime, patients are encouraged to take pain medication to help with the pain.

    Another complication, according to the UNC, can include constipation, a difficult time swallowing, an infection near the operation site and/or a wound infection on the surface.

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    Common Symptoms Of Hiatal Hernia

    Before understanding how to fix a hiatal hernia yourself, consider the following side-effects of this condition. As mentioned, a small hiatal hernia is usually harmless. However, a large one can easily lead to the following:

    • Shortness of breath
    • Regurgitation of liquids and foods in the mouth
    • Vomiting of blood
    • Feeling full quickly after eating

    What Causes Hiatal Hernias:

    As I briefly mentioned above, Hiatal hernias happen when the hiatus enlarges and allows the stomach or other organs to herniate into the chest.

    The diaphragm is a muscle that divides the chest from the abdomen and any condition or circumstances that weakens this area can predispose the patient to develop a hiatal hernia or paraesophageal hernia.

    • Sex: Women are four times more likely to develop a hiatal hernia versus male patients.
    • Age: The incidence increases with advancing age.
    • Genetics: Familial cases have been documented, so if you have a family member with a hiatal hernia you have a good chance of getting one.
    • Trauma or surgery: Any injury or surgery in this area can predispose hernia formation.
    • Congenital: Diaphragmatic hernias in babies are rare but not unheard of. The presentation can vary depending on the size and location within the diaphragm.
    • Weight: Morbid obesity is a big risk factor because of the increase in intra-adominal pressure.
    • Smoking or chronic respiratory conditions: Coughing increases the intra-abdominal pressure significantly, so any condition that promotes chronic coughing can increase your chance of having a hiatal hernia. Similarly, chronic vomiting, constipation or heavy lifting can be associated with Hiatal hernias.

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