Surgery treatment of hernia of the esophageal opening of the diaphragm

Surgical interventions in the hospital are covered by a loyalty program, which makes treatment even more affordable.

A hiatal hernia is a condition accompanied by the protrusion of the stomach, and sometimes other abdominal organs, into the chest cavity. It develops when the muscles and ligaments of the diaphragm become stretched and weakened. The diaphragm is a thin muscular partition between the abdominal and thoracic cavities.

Normally, the diaphragm has narrow anatomical openings through which the aorta and esophagus pass. In the case of the disease, the esophageal opening becomes enlarged. Because of this, when intra-abdominal pressure increases, abdominal organs protrude into the chest cavity.

Surgery is the only effective method of treating a hiatal hernia. Modern technologies allow it to be performed using a minimally invasive laparoscopic method. Its advantages are:

• access to the surgical area through 3 punctures up to 1 cm in diameter instead of a wide incision;

• the possibility of easier preoperative preparation and rehabilitation according to the Fast Track Surgery protocol;

• minimal damage to healthy tissues and low blood loss;

• reduced risk of complications;

• hospitalization of only 1–3 days;

• short and easy rehabilitation period.

At Oxford Medical, hernia surgeries are performed by top-category surgeons with many years of experience. They are highly skilled in laparoscopic techniques and have already performed hundreds of successful operations. Thanks to this, as well as the availability of expert-class diagnostic and endoscopic equipment in the clinic, every patient can be confident in the high quality of medical services.

In this case, surgical treatment is the main approach. Conservative therapy is rarely used and only in the early stages. The narrowing of the esophageal opening of the diaphragm can only be achieved surgically.

Indications for surgery are:

• risk of hernia incarceration (highest with paraesophageal hernia);

• pronounced symptoms of sliding hernia (heartburn, belching) requiring constant medication;

• presence of extra-esophageal symptoms of hernia (night cough, laryngitis, frequent relapses of bronchitis and pneumonia);

• Barrett’s metaplasia;

• severe form of gastroesophageal reflux disease (GERD), esophagitis (inflammation of the esophageal mucosa), erosions, ulcers;

• ineffectiveness of conservative therapy, development of side effects from acid-reducing drugs.

The decision on surgical treatment is made after thorough diagnostics and assessment of the patient’s health condition.

Before the surgery is scheduled, the patient undergoes a thorough examination. It is necessary to confirm the diagnosis, detect comorbidities, and exclude contraindications to surgery and general anesthesia.

The patient may be prescribed:

• gastroscopy – endoscopic examination of the esophagus, stomach, and duodenum;

• X-ray with contrast enhancement;

• computed tomography (CT) or magnetic resonance imaging (MRI);

• measurement of pH levels in the stomach and esophagus.

During hospitalization, an ECG and preoperative tests are also performed.

Oxford Medical surgeons work according to the Fast Track Surgery protocol. It facilitates preparation for surgery: no mechanical bowel cleansing or prolonged fasting is required. The surgeon provides detailed recommendations the day before hospitalization.

Most often, removal of the esophageal hernia is performed laparoscopically. Open surgery may be recommended in severe cases or in the presence of complications.

The laparoscopic surgery is performed as follows:

• The anesthesiologist administers general anesthesia.

• The surgeon makes several punctures up to 1 cm in diameter in the abdominal wall.

• Through one puncture, a laparoscope with a miniature video camera is inserted. The image is transmitted to a monitor with 40–60x magnification.

• Through another puncture, carbon dioxide is introduced into the abdominal cavity to enlarge the surgical field and improve visibility.

• After this, endoscopic surgical instruments are inserted, with which the surgeon performs the necessary manipulations.

• At the end, all instruments are removed, the carbon dioxide is carefully evacuated, and small sutures and sterile dressings are applied to the puncture sites.

After this, the patient is brought out of anesthesia and transferred to the intensive care unit, where they remain under monitoring for several hours.

The goal of surgical treatment is to eliminate the hernia and restore the anatomically correct position of the gastroesophageal junction. During the operation, the surgeon may perform:

• suturing of the esophageal opening of the diaphragm;

• strengthening of the diaphragm ligaments;

• restoration of the natural position of the stomach and its fixation (gastropexy);

• wrapping the upper part of the stomach around the lower end of the esophagus to prevent reflux of gastric juice into the esophagus (fundoplication).

The surgery allows for complete elimination of the pathology and its accompanying symptoms and complications. Statistics show absence of reflux in 94% of patients and absence of hernia recurrence in 85% of patients within 5 years after laparoscopic intervention.

The complexity and duration of rehabilitation depends on the type of surgery – open or laparoscopic.

After laparoscopy, usually the next day the patient is allowed to get up and walk in the ward, drink water and broth, and then gradually add soft foods to the diet.

The length of hospitalization is usually 1–3 days, and full recovery takes 3–4 weeks. During this period, the patient is advised to:

• take medications prescribed by the doctor;

• follow the recommended diet;

• limit physical activity and avoid lifting heavy weights.

Each patient receives detailed recommendations from the doctor. Successful recovery and absence of complications depend on following them.

The main cause of hernia development is dystrophy of the fascial ligaments of the diaphragm and a decrease in their elasticity. This can be caused by:

• congenital anomalies;

• age-related changes;

• obesity;

• excessive physical exertion and lifting of weights, which increases intra-abdominal pressure;

• multiple pregnancies;

• indirectly – tension of the occipital muscles, compression of the cervical spine, osteochondrosis.

 «Oxford Medical» – is a modern medical center with a high-tech surgery department. It is equipped with the latest expert-class equipment, which allows for operations of any complexity. Many of the clinic's surgeons have the highest medical category, degrees of candidate and doctor of medical sciences. Our main principle is to ensure the highest quality of medical care for each patient.

The cost of the operation depends on the severity of the disease and the method of surgical intervention - laparoscopic or open access. The price of laparoscopic surgery may be slightly higher due to the use of expensive equipment. However, it is less traumatic, requires shorter hospitalization and rehabilitation, which also reduces additional costs.

Get to know the cost of surgical treatment at «Oxford Medical» you can here. To find out a more accurate price taking into account the diagnosis, make an appointment with a doctor at a time convenient for you.