Laparoscopic Fundoplication and Hiatal Hernia Repair
Surgery is an effective treatment for gastroesophageal reflux disease and hiatal hernias. In this surgery, the valve between the esophagus and the stomach (the lower esophageal sphincter or LES) is reinforced and the hernia through the diaphragm is repaired.
Before you undergo surgery, it is necessary to make sure that it is the appropriate approach, as other conditions can mimic GERD and may not be helped by this surgery. Testing before surgery often includes:
- Upper GI endoscopy to evaluate the lining of the esophagus and the stomach
- Upper GI X-rays (barium swallow) to evaluate the anatomy of the hiatal hernia
- Esophageal manometry to evaluate the mechanical function of the esophagus
- Esophageal pH study to measure the severity of acid reflux into the esophagus
Surgery for GERD and a hiatal hernia is known as a laparoscopic fundoplication and hiatal hernia repair. It may be done by standard laparoscopy or by robotic-assisted laparoscopy. In this operation, the first step is to repair the hiatal hernia if one is present. This is done by first returning the herniated stomach to the abdominal cavity, and then repairing the diaphragm with sutures. In some cases, the repair of the diaphragm includes placement of mesh. The next step is to reinforce the lower esophageal sphincter. This is done by stitching (“plicating”) the top of the stomach (the “fundus”) around the lower part of the esophagus.
The recovery following fundoplication and hiatal hernia repair is like that of other laparoscopic procedures.
You will likely spend one night in the hospital after surgery, although some patients will need to stay in the hospital longer. Diet is started with thin liquids and then gradually advanced to thicker liquids and then semi-solid and soft foods. It is common to experience some slowness of swallowing due to swelling around the lower esophagus and the fundoplication. This symptom gradually resolves but may persist for several weeks. It is important to sit upright at mealtime and avoid carbonated beverages. Once you start eating solid food, it is important to take small bites and to chew your food thoroughly. You may feel full after a small portion of food, which will resolve over time. Most patients lose about 10 pounds while recovering from surgery.
Other common side effects include bloating, inability to belch or vomit, and increased flatulence. Although it may appear that you had a minor operation on the outside, you had major surgery on the inside. Your body will require time to recover.
Complications are rare, but can occur. It is possible that one of these complications will result in the need to convert to an open surgery or the need for further surgery. Complications may include:
- Injury to the liver, spleen, esophagus, stomach or other organs
- Prolonged difficulty with swallowing
- Failure of the operation to eliminate esophageal reflux
- Recurrence of hiatal hernia or reflux
- Disruption or slippage of the fundoplication
- Complications from anesthesia
To view a publication from Austin Surgeons on Laparoscopic Hiatal Hernia Repair, click here.