|Discussion in 'All Categories' started by Tracy - Jan 18th, 2012 1:22 pm.|
|I have a large hiatal hernia. I have vomited "coffee grounds" and for the 3rd night in a row, I'm sitting up all night due to regurgitation / choking on my vomit. I am 45 hrs old, around 5' tall, 135 pounds, so I am not obese. I'm concerned about surgery because I've heard a large percentage of patients will still have the symptoms after surgery, won't be able to vomit or burp again, etc. I've also read about a type of mesh that dissolves in your body but can't find a doctor who's heard of it (I've read that regular mesh can cause chest pain postoperatively). Thank you for addressing my concerns. I live in a rural area about 4-5 hours from Phoenix, AZ, looking for a doctor close to Phoenix if possible because my insurance is from the state. Thanks for your help.|
re: Hiatal Hernia by Dr M.K. Gupta - Jan 22nd, 2012 3:43 am
Dr M.K. Gupta
If Hiatus hernia is symptomatic then you should get the surgery done. Laparoscopic procedure is method of choice.
Laparoscopic Nissen fundoplication is just about the standard surgical treatment for patients with uncomplicated GERD. While many of those patients have an associated big hernia, it is usually small and repair is usually straightforward by reduction of the hernia, approximation of the diaphragmatic crura, and fundoplication. Although a technical learning curve is assigned to this operation, long-term answers are excellent inside a most of patients.
In contrast, surgical management of LDHH is controversial. The goals of repair are anatomic reduction of the hernia and a competent lower esophageal sphincter, and both can be accomplished either transabdominally or transthoracically. Successful reduction of the hernia may require extensive dissection with mobilization of both esophagus and stomach, and also the hernia sac should be completely resected from the mediastinum.
Crural approximation and fundoplication should be a natural part of the repair to avoid anatomical recurrence and postoperative GERD. Gastrostomy and gastropexy have also been used to anchor the stomach in the abdomen. More recently, closure from the diaphragmatic defect with prosthetic material (Good quality of mesh) continues to be proposed.
The success of laparoscopy for achalasia and GERD causes it to be tempting to provide laparoscopic method of progressively more patients with LDHH. Potential patient-related benefits are possible having a laparoscopic approach that include shorter hospitalization and fewer postoperative pain]. Preliminary reports also suggest that the functional outcome is much like that after open repair.
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