When the opening (hiatus) in the muscle between the abdomen and chest (diaphragm) is too large, some of the stomach can slip up into the chest cavity. This can cause heartburn (gastro-esophageal reflux: GER) as gastric acid backflows from the stomach into the esophagus. Hiatal hernia repair is surgery to repair a bulging of stomach tissue through the muscle between the abdomen and chest (diaphragm) into the chest (hiatal hernia).
Hiatal hernia repair may be recommended when the patient has:
- Severe heartburn
- Severe inflammation of the esophagus from the backflow of gastric fluid (reflux)
- Narrowing of the opening (hiatus) through the diaphragm (esophageal stricture)
- Chronic inflammation of the lungs (pneumonia) from frequent breathing in (aspiration) of gastric fluids
- Failure of medical management or Need for long-term medical therapy
- Complications of GERD (eg, Barrett esophagus or peptic stricture)
- Patient preference (eg, desiring discontinuation of medical therapy because of quality-of-life concerns, financial concerns, or intolerance to medication)
Surgical treatment involves repairing the hiatal hernia and re-creating a competent valve between the esophagus and stomach. Laparascopic Nissen Fundiplication involves fixing your hiatal hernia and wrapping the top part of the stomach around the end of the esophagus to reinforce the lower esophageal sphincter, and this recreate the “one-way valve” that is meant to prevent acid reflux. This can usually be done with 4 or 5 small laparoscopic incisions.