• Hiatal Hernia

The use of traditional surgery for the repair of hiatal hernias is no longer considered to be among the last options to be offered to the patient. The Laparoscopic approach to repair a Hiatal Hernia with a Nissen Fundoplication is now considered to be the standard surgical treatment; which is now considered to be a Minimally Invasive Surgical Procedure.

The Hiatal Hernia is caused by a defect at the base of the diaphragmatic muscle pillars, the crura, which normally has an opening that allows the passage of the esophagus from the thoracic cavity into the abdominal cavity. Because of this defect, the proximal part of the stomach is able to slide through this opening and partially herniated into the thoracic cavity.

The first laparoscopic Hiatal Hernia repair was done by doctors Dellamagne and Geaga in 1990-1991. The procedure was called the Laparoscopic Nissen Fundoplication.

This laparoscopic technique is done through 4 very small incisions ranging from 2mm to 10mm in diameter. The access into the abdominal cavity is done with the help of the laparoscope which in turn allows an excellent view of the entire abdominal cavity detailing the surgical site of the gastro-esophageal junction.

The reason that this type of surgery is possible is due to the presence of specially designed laparoscopic instruments such as: the endoscopic forceps and scissors, the endo-dissectors and graspers, endoscopic liver retractor, endo-clip applicators and mechanical staplers, as well as the cautery and suction, endoscopic needle holders, among others. By correcting the diaphragmatic defect via laparoscopic surgery, we avoid having to use the very large incisions used in traditional open surgery, which ranges from 10-15cms in diameter.

One of the main benefits of the Laparoscopic technique is that this approach causes much less trauma to tissues and organs, producing less pain to the patient. As a result of this, discharge is usually done within 24hrs after surgery if his condition is stable.

As in every surgical procedure there are possible risks and complications. Although some of these risks and complications have a decreased incidence with laparoscopic surgery, they should always be discussed in detail with your laparoscopic surgeon.