Hiatus Hernia Repair (Laparoscopic)

Laparoscopic Nissen Fundoplication (LNF) is considered the standard of care for hiatal hernia.

Procedure

Nissen Fundoplication is performed on an outpatient basis under general anaesthesia. Your surgeon makes a small incision in the upper abdomen and inserts a tube called a trocar through which the laparoscope is introduced into the abdomen. A harmless gas is injected into the abdominal cavity near the belly button to expand the viewing area of the abdomen, providing a clear view to your surgeon and sufficient room to work. Additional small incisions may be made to insert other surgical instruments.

During the procedure, your surgeon first repairs the hiatal hernia, by bringing your stomach down into your abdominal cavity. Sometimes, a type of mesh may be inserted to support and strengthen it. Your surgeon then wraps the upper part of the stomach, the fundus, around the lower oesophagus to create a valve, suturing it in place. This surgery strengthens the muscles and helps prevent stomach acid and food from flowing back into the oesophagus. The laparoscope and other instruments are removed and the gas released. The tiny incisions are closed and covered with small bandages.

Post–operative information

You may feel soreness around the incision areas. Your surgeon may prescribe pain medicine or non-steroidal anti-inflammatory drugs (NSAIDs) for the first few days to keep you comfortable. If the abdomen was distended with gas, you may experience discomfort in the abdomen, chest or shoulder area for a couple days while the excess gas is being absorbed.

Contact your doctor immediately if you have a fever, chills, increased pain, bleeding or fluid leakage from the incisions, chest pain, shortness of breath, and leg pain or dizziness.

Benefits of this approach

Laparoscopy is much less traumatic to the muscles and soft tissues than the traditional method of surgically opening the abdomen with long incisions (open techniques). In addition, infection risk is less, and patients experience less pain and scarring and a quicker recovery.

Preparation

You may be instructed not to eat or drink anything before the procedure. Your surgeon will give you instructions on the medications you need to avoid. Further investigations may be required prior to surgery to check the level of acid reflux and the movement of the oesophagus.

Outcome

As with any surgery, Nissen fundoplication may involve certain risks and complications which include post-operative fever and infection, injury to blood vessels, injury to stomach or oesophagus, swallowing difficulties, gas embolism, adhesions (extensive scar tissue formation can form in the surgical area) and recurrence of the hiatal hernia. If swallowing difficulties, bloating, belching and flatulence persist after surgery, you may require further corrective surgery.

Post-op stages of recovery and care plan

After the procedure, you will be able to leave the hospital in two or three days. You will be given specific instructions with regard to your diet. You are recommended to eat only soft food such as mashed potatoes or soup during the first six weeks after surgery as hard food can get stuck at the surgery site.

Down-time lifestyle or off -work duration

You can resume your regular activities within a week after the surgery. However, complete recovery takes around two to three weeks, during which time, you are advised to avoid hard labour and heavy lifting for three months after surgery.

Costs

Any costs involved will be discussed with you prior to your surgery.