REPAIR OF A HIATAL HERNIA (and of gastro-esophageal reflux)
The junction between the esophagus and the stomach (cardia) is normally maintained under the diaphragm with strong ligaments. In this position the cardia is a valve allowing the nutrients to pass through to the stomach but blocking the reflux of the gastric acid. If the ligaments are lose, a migration of the cardia through the diaphragmatic opening (hiatus) in the thorax can occur with loss of the valve function. The reflux of gastric acid can inflammate the esophagus - Gastro-Esophageal Reflux Disease- typically recognised with heartburn, a bitter taste, coughing.
One can speak of a sliding hernia with a reflux esophagitis.
The treatment of the hiatus hernia consists out repositioning the stomach under the diaphragm; by stitching the hiatal opening and recreate the anti-reflux valve. This valve is created by fixing the upper part of the stomach around the esophagus in a fundoplication, as from Nissen (360°) or Toupet (270°) (photo)
This intervention is justified if a conservative medical treatment is insufficient or resistant.
This intervention is performed on a regular base with excellent results on the long term with disappearing of the symptoms in 90% of the cases.
The principal adverse event is a sense of nutritional blockage (dysphagia) -for solid food- that can occur around 6 to 8 weeks after the intervention.
The procedure can be done by laparoscopy through 5 trocars holes (see picture). Discharge of the patient can be after 48 to 72 hours.