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This is the most frequent lesion of the digestive tract.
It occurs when the top of the stomach moves permanently or intermittently into the thorax via the hiatal orifice.
This happens by sliding in nine cases out of ten: the bottom of the oesophagus and stomach slide up into the thorax. This is due to excess weight or to an increase in pressure in the abdomen because of clothes (such as a corset, for example), worn too tight.
It can happen by rolling if the bottom of the oesophagus remains in place with just the stomach migrating into the thorax. This may be congenital or occur as a result of accident.
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The symptoms feature a gastroesophageal reflux. This is a burning sensation in the chest which increases when leaning forward.
Sometimes the signs can be misleading:
- Pain when swallowing
- Night-time coughing due to an irritation of the bronchial tubes as a result of acid reflux when the patient is lying down
- Frequent throat irritation, leading the patient to consult an ear nose and throat specialist
- Anaemia: a sensation of weakness and loss of colour due to bleeding caused by the hiatus hernia
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- eosphagitis : this is an inflammation of the lower oesophagus which in extreme cases can lead to ulceration.
- endo-brachy-oesophagus (EBO) : this complicated term refers to the transformation of the coating of the lower oesophagus into a gastric-type mucous membrane. This lesion, in rare cases, may become cancerous and require close observation.
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The purpose of the surgery is to put in an anti reflux valve. This is a very frequent operation, rarely causing complications. Nowadays it is carried out using laparoscopy (keyhole surgery) via 5 small incisions.
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The day before the operation :
No special examination is needed, unless your state of health requires it.
The day of the operation :
-The patient takes a shower with antiseptic and his/her abdomen is coated with antiseptic.
- Anti-thrombosis stockings are provided.
- On the morning of the operation, an anticoagulant is injected to prevent the risk of phlebitis.
- Premedication.
The operation :
The operation is carried out under general anaesthetic.
It lasts from 30 minutes to 1 hour.
In most cases, the operation is performed by laparoscopy via four 5 to 10 mm holes.
The advantage of this technique is that the patient returns to his/her normal way of life more quickly. The surgeon may, however, decide to make a conventional incision if he encounters difficulties during the operation.
The purpose of the surgery is to put in an anti reflux valve.
After the operation :
The purpose of this phase is to make sure there are no complications so the patient can return to his/her normal way of life. This phase begins in the recovery room, continues on the hospital ward and ends with a period of convalescence at home.
Recovery phase
When the operation is over, you are moved to the recovery room for at least 2 hours. Your state of consciousness, your pulse, your oxygen level, your breathing and any drainage tubes are all monitored. In exceptional circumstances, you may also have a nasogastric tube: a pipe going through the nose into the stomach to keep it clear. You may also have drainage tubes: pipes which draw away any secretions which might build up in the stomach.
Returning to the ward :
In the evening or on the day following the operation you will be made to get out of bed.
Any tubes or drains will be removed over the next few days.
You generally leave hospital on the day following the operation.
You begin eating again progressively, generally the evening after the operation, starting with drinks and then solid food little by little.
Dressings are removed at home, either by yourself, or with the help of a nurse..
Returning home :
During your convalescence for about a fortnight, you must liquidise your food so that your stomach can heal completely.
Gradually, you will be able to return to your normal activity
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Consequences and complications |
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Consequences
Once the hiatus hernia has been cured, acid can no longer enter the oesophagus. The symptoms due to the reflux disappear. However, if these were not caused by the reflux they will persist. It is therefore important to undergo examinations before the operation in order to determine whether eliminating the reflux will improve your condition.
You must eat slowly in order to avoid bloating; this can occur after meals for several months after the operation.
When food is being eaten, there is sometimes a sensation of it setting stuck. This problem normally disappears after a few months. Should it persist, one should consult the surgeon who will check the valve.
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Complications arising as a result of the operation
These are the same as with any type of surgery. Phlebitis, pulmonary embolism, haemorrage and infection may occur. During the operation, in exceptional cases, it may be necessary to open up to control haemorraging, for example.
The following complications specific to hiatus hernia surgery may be encountered:
Injury to the spleen: this is infrequent but the risk nevertheless exists on account of the proximity of this organ to the stomach.
- Dysphagia : difficulty in swallowing. This disorder should disappear in the months following the operation. If it persists, the valve is perhaps too tight; this can be corrected.
The list of these complications might seem alarming, but they occur very rarely where the operation is carried out by a well-trained team.
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No particular after-care is necessary following a simple hiatus hernia operation.
However, if you suffer from an endo-brachy-oesophagus (EBO), you should have a yearly check-up until it disappears.
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