Hiatal Hernia Treatment
|Giant Hiatal Hernia |
Lyall A. Gorenstein, MD
The most common symptom of hiatal hernia is gastroesophageal reflux (GERD), which may often be successfully treated with medication.
Hiatal hernias require repair for two main reasons:
- The patient's reflux symptoms are not successfully controlled with GERD medication therapy.
- The patient has a giant esophageal hernia (also known as intrathoracic stomach.)
If surgical treatment is required, our surgeons nearly always use minimally invasive anti-reflux techniques, including laparoscopy and endoscopy, with the type of procedure used depending upon the amount of stomach that has migrated through the diaphragm into the chest. GERD medications are not necessary after surgery.
Read more about hiatal hernia and the anatomical structures involved.
Repairing the Hiatus
An early-stage hiatal hernia may be repaired by decreasing the size of the enlarged hiatus (the opening in the diaphragm through which the esophagus travels on its way to the stomach). This is accomplished by means of sutures and a prosthetic mesh to reinforce the diaphragm tissue.
To repair and prevent a sliding hiatal hernia, Nissen fundoplication involves wrapping of the fundus (upper part) of the stomach around the bottom portion of the esophagus to create a bulge of tissue that holds the stomach in place below the diaphragmatic hiatus. Nissen fundoplication also reinforces the lower esophageal sphincter and alleviates reflux when it is present.
|The fundus (top of stomach) is wrapped around the esophogastric junction (the connection between the stomach and the lower esophagus).|
Paraesophageal hernia and intrathoracic stomach may be complicated when a short esophagus pulls upward on the stomach. In Collis-Nissen gastroplasty, the surgeon uses the upper portion of the stomach to extend the esophagus and ease this tension. Our team routinely uses minimally invasive laparoscopy to perform this procedure, which was traditionally performed through a major chest incision.