your doctor has recommended that you undergo surgery to repair a hiatal hernia but what does
that actually mean your diaphragm is a muscle that separates your chest from your abdomen
and helps you to breathe normally the diaphragm has an opening for the esophagus to pass through
where it connects with the stomach
a hiatal hernia occurs when part of the stomach pushes upward through the small opening your
hiatal hernia may be causing considerable discomfort with symptoms like heartburn difficulty
swallowing chest pain and belching the reasons why hiatal hernias form are not known but they
are quite common a hernia is dangerous only if it becomes strangulated that means that a portion of
the stomach that is pushed up into the chest may become pinched preventing blood from reaching it
if this happens you may require emergency surgery to restore blood flow and to repair the hernia
surgical procedures performed by making an incision large enough to expose the entire
operative area are called open procedures your doctor believes that your medical condition and
overall state of health make you a good candidate for a less intrusive laparoscopic surgery
a laparoscope is a narrow tube that contains a light source and a small video camera using
a laparoscope the surgeon is able to operate by making one or more very small incisions through
which the sterile laparoscope and possibly other instruments are inserted into the body
using the laparoscope's video camera the surgeon is able to explore and inspect the interior of the
abdomen often allowing the surgeon to see with greater detail and with more clarity than with
the human eye alone however it is important to understand that during the procedure your
surgical team is always prepared to convert a laparoscopic procedure to an open procedure
should they feel that your condition requires a more direct approach
if the surgical team makes this decision you will find upon waking
up that your doctor has made a larger incision and that healing may proceed more slowly
converting to an open procedure will affect the length of your recovery and will probably
require hospitalization of course no surgery is completely risk-free but your physician believes
that if you decide not to undergo the recommended procedure you may be putting your health at risk
after allowing a few minutes for the anesthetic to take effect a small incision is made above
the umbilicus then a hollow needle will be inserted through the abdominal wall
and the abdomen will be inflated with carbon dioxide
an umbilical port is created for the laparoscope
four more incisions will be made with care taken to keep the openings as small as possible
once in place the laparoscope will provide video images so the surgeon can insert the instruments
used to locate and pull back the liver in order to see the upper part of the stomach
first the surgeon pulls the stomach away from the hiatus or opening in the diaphragm
then the surgeon cuts away the tissue that connects the liver
and the stomach the surgeon can then dissect part of the diaphragm around the esophagus
this gives better access to the diaphragm and the esophagus
next the surgeon pulls the esophagus upwards
and closes the hiatus with sutures some hiatal hernias can cause persistent and
painful acid reflux and your doctor may decide to correct the problem surgically
in this case the surgeon divides and separates the
arteries that supply blood to the top of the stomach
after freeing the stomach from the spleen your doctor wraps the upper portion of the stomach
around the esophagus and sutures it into place
a rubber tube is placed in the esophagus to keep the wrap from becoming too tight
all of the instruments are withdrawn the carbon dioxide is allowed to escape
the muscle layers and other tissues are sewn together
and the skin is closed with sutures or staples finally sterile dressings are applied
you