Laparoscopic Repair of Giant Hiatus Hernia

In our experience of more than 500 giant hernias, repair is best performed by laparoscopic (keyhole) surgery. This is technically difficult and not all surgeons are comfortable performing this operation. Some surgeons use mesh to repair the hole in the diaphragm, but recent articles have confirmed that mesh repair is a risky procedure.

laproscopy

Laparoscopic Fundoplication for Large Hiatus Hernia showing a giant hiatus hernia with stomach passing through the hole in the diaphragm.

The complication rate of laparoscopic repair in our clinic is about 4% and about 14% if open surgery is performed. We would usually recommend laparoscopic repair.

There has been concern expressed in medical publications that these hernias can return, but several operations have demonstrated a satisfactory repair rate, similar to the clinic experience of 2% large recurrence and minor abnormalities in 8%.

Symptoms of poor exercise tolerance and shortness of breath are caused by giant hiatus hernia, and this is largely resolved by surgery. Heartburn and reflux do occur, but the most common symptom is chest pain, which can feel like it is a heart problem. Inability to eat a full meal is also a common symptom.

Quality of life following surgery has been found to be greatly improved, often with comfort and exercise ability trebling.

Risk of Giant Hiatus Hernia

barium_hernia

Barium Meal of a Giant Hiatus Hernia with normal stomach position showing.

The hernia can twist and strangulate causing bleeding, chest pain, collapse, rupture or loss of blood supply. This can occur after many years of considerable discomfort and the hernia becomes larger over time. It is important to treat Giant Hiatus Hernias early, as in some older patients they can be fatal.

Repair of this condition has been performed by our service for nearly 20 years. It usually results in patients only needing to be in hospital for the day or to stay overnight. There is little pain and recurrences have virtually been eliminated. Not everybody is suitable for keyhole approach. Early return to work and activity, within days, is expected. Few complications occur. Satisfaction is reported in our service as high, more than 95% of patients content.

Watch Professor Falk perform a giant hiatus hernia repair:

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