A GUIDE TO KEYHOLE SURGERY IN HIATUS HERNIA REPAIR

This guide has been written for people who want to find out more about hiatus hernias and, in particular, the use of keyhole surgery in the treatment of this condition. Whilst this guide offers general information about Nissen Fundoplication and keyhole surgery, you should always discuss the details of your particular case with your GP or specialist.

Introduction

The diaphragm is the thin muscular sheet separating the stomach, and other digestive organs in the abdomen, from the heart and lungs in the chest. There is a small opening, called the hiatus, where the gullet (oesophagus) passes through the diaphragm from the chest to the. A hiatus hernia is the protrusion of the stomach up into the chest through this opening.

A hiatus hernia allows the acid digestive juices produced in the stomach to pass up into the oesophagus. This is sometime referred to as gastroesophageal reflux. Symptoms include regurgitation (reflux) heartburn, difficulty in swallowing, vomiting and breathing problems.

These are usually treated by:

• taking antacid drugs
• raising the head of the bed
• avoiding tight or restrictive clothing
• keeping a normal body weight
• not bending after eating

If these measures do not work then your doctor may recommend surgery.

Surgical procedures for repairing a hiatus hernia

The operation for this is called Nissen Fundoplication, after Mr Nissen, the surgeon who first pioneered this type of surgery. The word Fundoplication refers to the surgeon's action on the stomach during this operation. This operation can be carried out by either traditional open surgery or by keyhole (laparoscopic) surgery. In either method this involves replacing the stomach back to its original position under the diaphragm and use of the Fundoplication technique to stop any stomach acid passing back up into the gullet.

Open surgery involves a large incision in the chest through which the surgeon carries out the operation and usually requires about 10 days in hospital and a long recovery time.

Keyhole surgery involves one or more small incisions through which special surgical instruments are passed into the body. The surgeon is able to see inside the body using an instrument called a laparoscope. A laparoscope is a form of telescope with a powerful light source. A miniature video camera is connected to the laparoscope and this shows a clear image on a television screen. Viewing the operation on the monitor, the surgeon is able to manipulate the laparoscope and surgical instruments from outside the patient's body to carry out the surgical operation from within.

To create space around the organs and to allow the surgeon a clear view, carbon dioxide gas is introduced into the abdomen. Five small incisions are then made in the abdomen through which the surgeon passes the laparoscope and other surgical instruments which enable him to return the stomach hernia back to its original position. The surgeon then wraps the upper few centimetres of the stomach around the oesophagus to prevent acid reflux and heartburn recurring.

Benefits

The main benefits of the keyhole operation are:

• less pain
• minimal scarring
• reduced risk of infection
• faster recovery time (usually only a 2 to 3 day hospital stay)
• back to normal activity within 2 weeks

Occasionally, during an operation, the surgeon may discover an additional problem which complicates the procedure. In this situation, the surgeon will need to make a number of decisions, which might include converting from keyhole to open surgery. Ask your surgeon to explain the surgical procedure and any possible complications before your operation.