This is performed for the treatment of hiatus hernia and gastro-oesophageal reflux.
What is hiatus hernia and gastro-oesophageal reflux?
Our stomach's are normally within the belly (abdomen). A muscular partition called the diaphragm separates the abdomen from the chest and has an opening (hiatus). through which our gullet (oesophagus) enters into the abdomen. In some people the hiatus may dilate and part of the stomach may slip into the chest through this opening - this is known as a hiatus hernia and can lead to acid entering the gullet (reflux).
What symptoms may I suffer from if I have a hiatus hernia?
Patients may experience heartburn, upper abdominal pain, bitter fluid in the throat and belching. Some may experience chronic cough, especially in the early hours.
How is a hiatus hernia diagnosed?
The diagnosis is usually made by performing an endoscopic examination of your gullet and stomach (OGD). Other tests may assist in making the diagnosis - these include a barium swallow and a CT scan of your abdomen. Your surgeon may also request a test to check that your gullet functions normally (oesophageal physiology).
What treatments are available for hiatus hernia?
Your surgeon may prescribe you medicines to reduce the acid secretion in your stomach. Less acid in the stomach will usually mean that less is available to flow up (reflux) into the gullet and your symptoms will usually be relieved. However, if you have bile entering your stomach and the gullet then reducing the acid in the stomach may not help to relieve your heartburn. You will also feel better if you avoid heavy meals, lose weight and avoid smoking. If you are happy with these measures then you may not need any other treatment. One concern with long-term medication is the concern that patients are more at risk of developing infective diarrhoea. However, if you are unwilling to continue to take medication long-term then an operation to refashion the valve that controls acid reflux may help. There are a number of anti-reflux operations but the common element is to repair the hiatal defect and wrap the upper stomach around the lower gullet (fundoplication). These operations can be performed using keyhole surgery.
What happens at the first appointment?
Your surgeon will initially take a history, examine you and perform appropriate tests to identify the cause of your symptoms. He will also ensure that you are fit to undergo any procedure / surgery and an anaesthetic. He may also suggest initial trial of medical treatment for your symptoms.
What happens at the subsequent appointments?
He will check that all necessary information and reports are available and have been evaluated. He will discuss the results and reports of various investigations. He will assess your response and satisfaction with the trial of medical treatment for your symptoms. He will discuss with you the various options available to treat your symptoms. If you want to undergo anti-reflux surgery then he will agree with you a date for the procedure.
Admission for surgery
You must not eat any food from 6 hours before the operation. You are allowed to drink clear fluids, including tea and coffee without milk up to 3 hours before the operation. A nurse will admit you on the day of surgery. The surgeon and the anaesthetist will see you prior to your operation. They will confirm that you are willing to undergo surgery, all preparations are complete and it is safe to proceed with your operation. They will confirm that an appropriate facility is available for you to recover after surgery.
What happens during surgery?
The operation is performed under general anaesthetic and a small ‘telescope’ (laparoscope) is passed into your abdomen above the navel. Your abdomen is filled with carbon dioxide gas, to help see everything properly. Further 3-4 small cuts will be made in your abdomen to insert instruments to help with the operation. The surgeon will repair the dilated hiatus with stitches and wrap the upper stomach around the lower gullet (fundoplication).
What happens in hospital after surgery?
You will be sent to the Ward after the procedure. You will be looked after by a nurse and offered appropriate pain-killers. You will be offered fluids to drink but you will not be allowed to eat solid food. Usually the procedure is performed as a day case or a short 1-2 day hospital stay and you will be able to return home when it is safe to do so. You will have a few small wound dressings which you can remove yourself after 1 week or a nurse / the surgeon can remove these at a subsequent visit. You will need to have a responsible and capable adult to take you home and to look after you for the first 24 hours. You should not operate machinery during this period.
Support available during early recuperation period after surgery
It is advisable to consume liquids only for the first 1-2 weeks to allow the swelling around the gullet to settle. You will gradually progress through soft diet to normal diet over 1-2 months. It is usual for you to experience some initial difficulty in swallowing and pain in the wounds - you may also experience minor discomfort in the shoulder. It is advisable to avoid strenuous physical activity for the first 2 weeks to allow proper healing of the wounds. Most patients recover fully within 1-2 months. You will be given a number to ring for advice in case of difficulty.
Further follow up after surgery
You will be given an appointment to see the surgeon again - he will ensure that you are recovering as expected.
Will further surgery be needed?
This is usually not necessary, though rarely corrective endoscopy or surgery may be required if you experience unexpected symptoms.
