Hiatal Hernia Repair
Hiatal Hernia Repair is a surgical procedure to reduce the stomach back down to the abdomen to treat symptomatic hiatal hernia. This procedure is performed along with either Nissen fundoplication, Toupet fundoplication or LINX.
We use the most advanced robotic system called Da Vinci Xi to perform hiatal hernia repair. The name of the procedure is “Robot-assisted laparoscopic hiatal hernia repair.” We perform the procedure through five small incisions in the abdomen. We mobilize and remove the hiatal hernia sac that allows the stomach to be reduced back into the abdomen. Next, we close the diaphragm with sutures reinforced with pledgets and perform Nissen fundoplication, Toupet fundoplication or LINX.
In order to ensure that the closure of the diaphragm and the wrap around the esophagus is not too tight, we use a balloon called an Endoflip to tailor the fundoplication. This is performed during the operation. The balloon catheter is placed through the mouth into the stomach and the esophagus and removed at the end of the operation.
Overall, the risks of the operation are very low. With any operation, there is a risk of injuring any structure that we operate around including the esophagus, stomach, liver, spleen, vagus nerve, diaphragm and the pleura. Other risks include bleeding and infection at the site of surgery. There is always a risk of needing to convert from a small incision to a larger incision.
Hospital Stay: 1 Day
After the operation, the patient goes to a recovery area called PACU or post-anesthesia care unit. Once the patient recovers from anesthesia, the patient is admitted under observation on the floor. On average, patients are in the hospital for one night.
The diet is dependent on which type of wrap is performed along with the hiatal hernia repair. Please see
- Nissen fundoplication
- Toupet fundoplication
for details of the diet.
We also advise our patients to stay ahead of the pain with pre-emptive pain control. Instead of taking pain medication after having pain, we ask patients to take pain medication in regular intervals. The typical regimen for post-operative pain medication is:
3 days of Aleve (Naprosyn) 1 tabs two times a day
5 days of Tylenol (Acetaminophen) 1 g three times a day
After 5 days, take Tylenol as needed. If this regimen is not adequate to control pain, we ask patients to call our office.
In order to further help with recovery from surgery, we advise patients to walk at least three times a day, work on the incentive spirometer, and sit in a chair for at least 6 hours a day for about a week after the surgery. We advise patients to avoid heavy lifting for 6 weeks. As long as the patient is not on narcotic pain medication, it is safe to drive.
One of the things that we want patients to avoid during the recovery period is being constipated. Constipation can cause an increase in intra-abdominal pressure that can put a strain on the repair. We recommend taking over the counter stool softener such as Dulcolex or Colace to make sure they have normal bowel movements.
A common side effect of this operation is bloating. This is caused when patients swallow air and it gets trapped in the stomach with a new barrier between the esophagus and the stomach. This usually gets better over time but in order to minimize discomfort, we ask patients to take Gas-X four times a day for 1 month.