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Paraesophageal Hernia and Hiatal Hernia

Hiatal hernia (HH) is a common disease, especially in older adults, with a rising incidence over the last two decades. It is the most common form of diaphragmatic hernia, and it is generally classified into four categories: type I (sliding), type II (pure paraesophageal), type III (mixed), and type IV (complex) 

 

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AFTER SURGERY

In most cases you will be sent to the recovery room for several hours to revoker from the anesthesia.  Depending on the extent of the repair, you may be admitted for 24 hour observation.  This will allow you to start a limited clear to full liquid diet to be sure you can tolerate the repair.  

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You will need a family member to drive you home and you should not drive a vehicle for 24 hours and not while taking narcotic pain medications.  

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You can remove your dressings after 24 hours and shower.  Do not immerse the incisions in a tub or pool for 2 weeks.  

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Do not apply antibiotic ointment or peroxide to the incisions unless told to do so

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You can have a soft diet, however it may help to start with a clear diet and advance this as you can to a more regular diet.  

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Resume normal activity

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Resume your home medications

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You should be discharged with ibuprofen 600 mg that you will take every 6 hours while awake for 48 hours.  You will also receive a narcotic pain medication, anti nausea medication to take  as needed.

 

We will see you in the office in one-two weeks for a post op check.   

Surgical treatment of HH and Giant Type III Paraesophageal Hernia is highly recommended by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) because they are prone to life-threating complications like gastric volvulus and strangulation [1]. In addition, subtle underlying symptom effecting quality of life are overlooked such as shortness of air, bloating, chest pain, early satiety, cardiac dysfunction.  

 

Indications for Giant Paraesophageal Hernia Repair or Fundoplication

  1. Symptomatic Relief:

    • Persistent symptoms such as severe gastroesophageal reflux disease (GERD), dysphagia (difficulty swallowing), or chest pain despite medical management.

  2. Complications:

    • Strangulation or incarceration: Evidence of compromised blood flow to the herniated stomach, which can lead to necrosis and require urgent intervention.

    • Esophageal obstruction: Significant interference with the passage of food or fluids.

    • Hemorrhage: Gastrointestinal bleeding or other bleeding complications associated with the hernia.

  3. Impairment of Quality of Life:

    • Severe symptoms leading to significant impairment of daily activities and quality of life that has not responded to conservative treatments.

  4. Potential for Progression:

    • Evidence of worsening hernia with increasing symptoms or complications, indicating a higher risk of severe outcomes if left untreated.

Laparoscopic Surgery:

  • Success Rate: Laparoscopic repair has a high success rate with a significant reduction in postoperative pain and quicker recovery. Success rates are typically around 90-95% for symptom relief and anatomical correction.

  • Recurrence Rate: Recurrence rates after laparoscopic repair are generally between 5-10% over a long-term follow-up period.

 

 

 

  1.  Zaman JA, Lidor AO (2016) The optimal approach to symptomatic paraesophageal hernia repair: important technical considerations. Curr Gastroenterol Rep 18(10):53.

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