If you have been experiencing recurrent episodes of heartburn and acid reflux into your chest, you may be suffering from a hiatus hernia. “Hiatus” is basically an opening in the diaphragm which is a muscular wall separating the chest from the abdominal cavity. In the normal scenario, the food-pipe passes through this opening and continues as the stomach. In a hiatus hernia, this opening may be enlarged and the stomach may in turn slip upwards into the mediastinum. A hiatus hernia is mainly of two types:
Causes of hiatus hernia
Exact cause for a hiatus hernia is not known. It is more commonly seen in women. Obese individuals are at a higher risk of developing a hiatus hernia. Some people may be born congenitally with a larger hiatal opening. Conditions causing increased intra-abdominal pressure such as chronic cough, constipation, pregnancy etc may lead to a higher incidence of hiatus hernia.
Small hiatus hernias may be asymptomatic and may not need any treatment. Symptoms of a hiatus hernia generally include:
If you are experiencing these symptoms on a regular basis then you must seek an appointment with your doctor at the earliest.
Your doctor will take a detailed history and carry out a clinical examination. If a hiatus hernia is suspected then following tests need to be carried out:
Treatment of hiatus hernia depends on the severity of symptoms and grade of hiatus hernia. Most patient have a small asymptomatic hiatus hernia and do not need any particular treatment. In case of symptomatic hiatus hernias medical or surgical treatment may be recommended based on the grade of severity.
Laparoscopic Nissen fundoplication surgery is the most commonly performed operation for management of hiatus hernia. Fundoplication surgery for GERD may either be performed through conventional laparoscopy by 5 tiny sub-centimetre cuts on the abdomen or by the single incision technique which is practically scarless.
Laparoscopic Nissen fundoplication surgery involves, pulling the stomach back down into the abdominal cavity, dissecting and removing the hernia sac and approximating the hiatal defect. Laparoscopic Nissen fundoplication surgery also includes a 360 degree stomach wrap to prevent it from once again migrating up into the chest cavity. Laparoscopic Nissen fundoplication surgery is performed under general anaesthesia and usually takes about an hour. Rarely, a mesh may be needed for repair of very large defects.
Laparoscopic Nissen fundoplication surgery cost depends on a lot of factors. Fundoplication surgery for GERD cost depends on the clinical profile of the patient, duration of surgery, class of room selected etc. Rarely a mesh may be needed for very large defects and it may increase the cost of laparoscopic Nissen fundoplication surgery. Cost of laparoscopic hiatal hernia repair surgery is usually covered by health insurance.
After you have consulted the doctor, you will need to get certain investigations done. Once your investigations have been seen by the doctor and you are medically fit to undergo surgery, a date will be fixed for surgery. If you are on any blood thinner medications, they will need to be stopped atleast 5 days before the surgery. You can get admitted either one evening before or on the morning of surgery based on doctor’s instructions. You will also be guided about the cost of inguinal hernia repair surgery during this time.
Degree of pain is much less after laparoscopic surgery . You will be covered with round the clock analgesics during the hospital stay. You will be able to walk around within 4 to 6 hours after laparoscopic surgery.
Most often patients get discharged on the day after their surgery. However, it depends on their clinical profile and condition.
It is advised not to lift any heavy weights and perform any strenuous activities. Patients will be on a liquid diet for two days after surgery after which they proceed to soft diet and then to normal home diet.
You can get back to work within a week after surgery. However, it may vary depending on your clinical condition. Some patients may get back even earlier than a week after surgery and rarely some may take a bit longer.
Rarely a hernia may recur even after surgery. This depends on a lot of factors like the tone of the abdominal wall, size of defect, intra-abdominal fat content etc.