A laparoscopic hiatal hernia repair is a minimally invasive approach that involves specialized video equipment and instruments that allow a surgeon to repair the hiatal hernia through several tiny incisions, most of which are less than a half-centimeter in size. The concept of the repair remains the same as the open approach. The organs that have herniated into the chest are reduced back into the abdomen, the hernia sac is removed, the diaphragm is repaired using either sutures of a piece of mesh, and part of the stomach is wrapped partially or completely around the esophagus in order to prevent further reflux symptoms. The advantages of this method include a shorter hospitalization, less pain, fewer and smaller scars, and a shorter recovery. Recently, we have been using the robot to perform robot assisted hiatal hernia repair. Robot is a technology that enhances the surgeon’s ability to perform minimally invasive surgeries with improved visualization.
Robot assisted or laparoscopic hernia repair is a safe and effective treatment for hiatal hernias. However, in the presence of infection, adhesions, or variations in anatomy, this method becomes dangerous and your surgeon may need to make the prudent decision to continue by making the traditional incision to safely complete the operation. This should not be seen as a failure, but as a wise decision by your surgeon to prevent dangerous complications. Other complications, although rare, include bleeding and infection. It is uncommon to require a blood transfusion for this operation. There is a slight risk of injury to the vagus nerve, esophagus, liver, stomach, bowel, lung, and spleen. Post-operatively, rare problems may occur. These include difficulty with swallowing or the repaired area slipping back into the chest.
After the operation, most patients take clear liquids next day and remain on full liquid diet starting 2 days after the operation and return to normal diet in 2 weeks. The typical hospital stay is 1-2 days, and many patients can return to work after two weeks. If the surgery is done open instead of laparoscopically, patients may need to take about 6 weeks off work. Heavy lifting is typically restricted for six weeks or more.
Long Term Outcome
Minimally invasive hiatal hernia repair is a long-term treatment for hiatal hernia. Over 80 to 90% of the patients who undergo the operation has resolution of symptoms.