Hiatus Hernia (GERD)/ Laparoscopic Fundoplication in Mumbai, India
Hiatus hernia is more commonly seen that it is thought of. It is a type of internal hernia, where the upper part of the stomach bulges or herniates upwards into the chest through an enlarged opening in the diaphragm. Diaphragm is a sheet of muscle that separates the chest from the abdominal cavity. Weak diaphragmatic musculature usually gives rise to a hiatus hernia. Hiatus hernia can also be congenital and seen in young children. It may occur in those who are into rigorous weight lifting, those with severe constipation or those with chronic cough. It is more common in elderly people and those suffering from obesity.
Types of hiatus hernia
A hiatus hernia is mainly of two types:
- Para- oesophageal hernia– This is a less common type of hiatus hernia. In this case the stomach and the food-pipe remain in their natural places. A portion of the stomach squeezes up into the hiatal defect. This type of hernia although less common gives more cause for concern as there is a risk that the stomach tissue may get strangulated and its blood supply may be hampered.
- Sliding hiatus hernia– This is a more common type of hiatus hernia. In this type, the stomach and the food-pipe slide up into the chest.
Signs and symptoms of hiatus hernia/GERD
- Symptoms of hiatus hernia can vary from having no symptoms at all, to severe acid reflux.
- Heartburn, acidity, difficulty in swallowing, vomiting, acid reflux etc are seen in patients with hiatus hernia and GERD.
- Symptoms tend to increase on lying down or bending down and decrease in upright position.
- In severe cases of reflux, patients may also experience breathlessness and asthma like symptoms.
- At times, there may be ulcer formation which may lead to blood in vomiting or black coloured stools.
Investigations
A detailed history and clinical examination are performed. If a hiatus hernia is suspected then following tests need to be carried out:
- Barium swallow or an esophagogram- During this test, you will be made to drink barium which is a sweet chalky liquid and the silhouette of the stomach will be seen on fluoroscopy through an x ray machine. In cases of hiatus hernia, stomach can be seen herniating into the chest.
- Upper GI endoscopy- In this test, an endoscope is passed through the mouth into the stomach and the first part of intestine (duodenum). The size and grade of hiatal defect can be visualized in an UGI endoscopy. Endoscopy can be done under sedation or under anaesthesia.
- 24- hour pH manometry- In this test a thin tube is passed through the nose into the stomach. This tube measures the pressure and movement of acid inside the food-pipe.
Hiatus Hernia Treatment
- First line of treatment for hiatus hernia is through lifestyle and behaviour modification as well as medications. Eating small frequent meals, non-spicy and less oily food, early dinner and sleeping with two pillows under the head to keep it elevated are some of the conservative methods. Antacid medications help in some patients.
- Surgery is advised for patients who are not relieved despite being on medications for a long period, or those who are not able to stop medications or those who are developing complications like Barrette’s oesophagus, asthma like symptoms or ulcer formation.
- Hiatus hernia surgery is performed laparoscopically through key holes. 4-5 tiny cuts of about 0.5 to 1 cm are made in the abdomen and the entire surgery is performed through these. The surgery entails tightening of the hiatal valve and a wrap of the stomach. It usually takes about 60 to 90 minutes depending on the grade of difficulty of the surgery. Most patients are allowed to start taking oral diet within 6 hours of surgery and are discharged from the hospital the next morning. Patients are able to get back to work within a week’s time.
- Hiatus hernia surgery or laparoscopic Nissen’s fundoplication is a surgical procedure performed for the treatment of Hiatus Hernia and GERD. Myths and fear of surgery sometimes lead to delay in treatment and may give rise to complications that could have been avoided. This surgery is generally safe and if you are detected with a hiatus hernia, please visit your surgeon for the right advice.
Video link- Patient review- Laparoscopic Fundoplication-
Cost of hiatus hernia/ laparoscopic fundoplication surgery in Mumbai
Cost of hiatus hernia/ laparoscopic fundoplication surgery in Mumbai varies from hospital to hospital. We are associated with multiple hospitals and believe that quality treatment must be accessible to all. Post your consultation we will guide you about the best possible option for your surgery.
Insurance coverage for hiatus hernia/ laparoscopic fundoplication surgery in Mumbai
Hiatus hernia/ laparoscopic fundoplication surgery is covered by health insurance.
Frequently asked questions
How can I prepare for hiatus hernia surgery?
After consulting the doctor, get the investigations done. Once the 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 same morning of surgery based on doctor’s instructions.
Is hiatus hernia surgery/laparoscopic fundoplication painful?
Pain is much less after any 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 and most likely will be discharged from the hospital within 24 to 36 hours after the surgery.
What precautions must be taken after hiatus hernia repair surgery?
Liquid diet is advised for two days after surgery after which soft diet is started for a couple of days. Normal home cooked diet is started within 4 to 5 days of surgery. It is advised not to lift any heavy weights and perform any strenuous activities for a couple of months after surgery.
When can I get back to work after hiatal hernia surgery?
You can get back to work within a week after surgery. However, it may vary depending on your clinical condition.
Can a hiatus hernia recur even after surgery?
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.
Is surgery necessary for a hiatus hernia?
This depends on the size of the hiatus hernia and the symptoms that a patient is experiencing. If despite continued medical management there is no relief, surgery is advisable. Surgery is also advisable if patient is not able to stop medications.
To watch Hiatus Hernia surgery/ Laparoscopic Nissen Fundoplication by Dr. Aparna G Bhasker, please click on-
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