Hiatus Hernia Fundoplication in Ahmedabad

Experiencing acid reflux and heartburn due to a hiatal hernia? Our expert surgeons at Tirtham Surgical Hospital can assist. Get specialised hiatus hernia fundoplication surgery in Ahmedabad and enhance your quality of life.

Hiatus Hernia Fundoplication treatment

Our team of experienced surgeons (16+ years of experience) utilise advanced, minimally invasive techniques to ensure a quick recovery for your hiatus hernia. We also customise each treatment plan for optimal results.

What is Hiatus Hernia Fundoplication?

Hiatus hernia fundoplication is a surgical procedure used to treat hiatus hernia. A hiatus hernia occurs when the upper part of the stomach bulges upwards into the chest through an opening in the diaphragm.

This condition leads to gastroesophageal reflux disease (GERD), which has symptoms like heartburn and acid reflux.

Why does it Occur?

Although the actual and exact cause of hiatus hernia is not known, but is a very common condition. The causes may include:

Being born with a larger hiatal opening than usual
Weakness of the supporting tissue
Injury to the area
Changes in the diaphragm with age
A rise in pressure in your belly due to pregnancy, coughing or age
Obesity
Smoking
Lifting something heavy
Straining on the toilet

Hiatus Hernia happens mostly in women, people with overweight and people older than 50.

Common Symptoms of Hiatus Hernia

You may have no symptoms at all in most cases. However, it varies from person to person. Following are the symptoms of hiatus hernia that you may experience:

Heartburn from gastroesophageal reflux disease (GRED)
Acidity
Chest Pain
Difficulty swallowing
Bloating and burping
Bad taste in the mouth
An upset stomach and vomiting
Backflow of food and liquid from the stomach to the mouth
Pain in the chest or belly
Ulcer formation in the stomach leads to bloody vomit or black-coloured stools.
Constipation

Symptoms may increase if you are lying down or bending down. You may feel less or no symptoms if you are sitting in an upright position.

How is a Hiatus Hernia Diagnosed?

First, your doctor will perform a detailed history and clinical examination. If the doctor suspects a hiatus hernia, then the following tests will be carried out:

Barium Swallow or an Esophagogram: The doctor will ask you to drink a liquid with barium, including a sweet, chalky liquid. Then, the doctor will check the silhouette of your stomach through an X-ray machine.
Upper GI Endoscopy: Your doctor will insert an endoscope, a long, thin tube, through your mouth into your stomach. The endoscopy will help detect the size and the grade of the hiatal defect. The doctor will perform an endoscopy under sedation or anesthesia.
24-hour pH Manometry: The doctor passes a thin tube through your nose into your stomach. The tube measures the pressure and movement of acid inside your food pipe.
pH Test: The test will measure the acid levels in your oesophagus.

What are the Treatment Options for Hiatus Hernia?

Most people won’t need treatment as there will be no noticeable symptoms. However, your doctor will decide on the best long-term treatment depending on the severity of the symptoms and the nature of your hernia.

There are two types of treatment options: non-surgical treatments and surgical treatments.

1.Non-Surgical (Conservative) Treatments: Lifestyle changes are the most important treatment for hiatus hernia. Your doctor may also prescribe some medications if needed.

Avoid food and beverages, such as fatty food, spicy food, caffeine and alcohol.
Eating smaller and more frequent meals
Avoid lying immediately after eating
Raising the head of the bed or using an extra pillow to prevent nighttime reflux.
Antacids to weaken or neutralise your stomach acid
Proton Pump Inhibitors (PPIs) promote the healing of the oesophagus
H2 Receptor Blockers to reduce acid production
Prokinetics help strengthen the lower oesophagal sphincter and improve gastric emptying.

2.Surgical Treatments: If conservative treatments fail to relieve your symptoms or complications, your doctor may suggest surgical options.

Hiatus Hernia Repair: The hernia is reduced back into the abdomen, and the opening of teh diaphragm is tightened.

Hiatus Hernia Fundoplication: Nissen Fundoplication is one of the most common procedures. In it, the doctor wraps (360 degrees) the top part of your stomach around the lower oesophagus. The next procedure is partial fundoplication, with procedures like Toupet (270-degree warp) or Dor (180-200-degree wrap).

Laparoscopic Surgery: Minimally invasive surgery involves small incisions, a camera and specialised instruments, leading to less pain and quicker recovery.

Endoluminal Fundoplication: It is a less invasive endoscopic procedure in which the stomach is wrapped around the oesophagus from the inside using a specialised device.
Transoral Incisionless Fundoplication (TIF): Another endoscopic technique to wrap the stomach around the oesophagus without incisions.

What Happens if Hiatus Hernia is Left Untreated?

Many assume that because they aren’t experiencing any significant or bothersome symptoms, the hiatal hernia is not a big problem.

Hernias tend to get worse or larger if not addressed on time. Mild symptoms can turn into more serious ones, possibly spiralling into serious complications.

Potential complications include:

Gastroesophageal Reflux Disease (GERD): A Hiatus Hernia can cause stomach acid to flow back into the oesophagus, leading to heartburn, sour or bitter-tasting acid backing up in the mouth and difficulty swallowing.
Esophagitis: An inflation in the oesophagus due to chronic exposure to stomach acid. This leads to chest pain and bleeding that may cause anemia.
Barrett’s Oesophagus: Changes in the oesophagal lining due to prolonged acid exposure are called Barrett’s oesophagus.
Esophageal Stricture: Scar tissues may form, leading to the narrowing of the oesophagus. This happens due to repeated inflammation and healing. You may experience difficulty swallowing and food impaction.
Respiratory Problems: Acid reflux can lead to persistent coughing and asthma. Aspiration pneumonia, caused by inhaling stomach contents into the lungs, can also lead to infection.
Ulceration and Bleeding: Severe acid reflux can cause ulcers, leading to vomiting in blood and black stools.
Strangulation and Obstruction: Blood supply to the trapped stomach tissue may be cut off, requiring emergency surgery. Blockage of food passage can cause severe pain and vomiting.

Regular monitoring and treatment for a hiatus hernia are crucial to prevent these complications.

How is the Hiatus Hernia Fundoplication Surgery Performed?

Hiatus Hernia Fundoplication Surgery is a complicated procedure to repair a weakened diaphragm muscle and prevent stomach acid reflux. Your surgical team will carefully assess your overall health to determine the best course of action and prepare you for surgery.

Here is how the surgery is performed:

1.Preparations:

Your healthcare providers will review your medical history and current medications. They may also provide specific pre-operative and post-operative care instructions for a smooth and fast recovery.

2.Tests:

Your surgeon may order tests to examine your stomach and oesophagus. The tests may include:

GI X-rays (barium swallow X-rays) to take images of your oesophagus, stomach and small intestine.
Oesophageal Manometry to measure the pressure in your oesophagus when you swallow
Upper Endoscopy to examine the upper part of your stomach.
A pH probe to look for evidence of acid in your oesophagus.

The healthcare providers may also ask you not to eat or drink a few hours before the surgery.

3.The Procedure:

Depending on the type of surgery you require, your healthcare professional may opt for open or laparoscopic surgery. In both cases, an anesthesiologist administers IV medication for sedation.

For an open acid reflux surgery, the surgeon:

First, make one large incision in your abdomen
Wraps the upper part of the stomach (fundus) around the lower part of the oesophagus.
Then, close the incision with staples.

For a laparoscopic fundoplication, the surgeon:

Incisions: Makes several small incisions in your abdomen. (usually 5 to 6)

Insertion of Tools: Insert a laparoscope (a thin tube with a camera) and other surgical instruments into your abdomen through the incisions.

Reduction of Hernia: The surgeon pulls the herniated part of the stomach back into the abdominal cavity from the chest cavity.

Repair of the Diaphragmatic Hiatus: The hiatus, the opening in the diaphragm through which the oesophagus passes, is often tightened with sutures to prevent stomach herniation.
Fundoplication: The upper part of the stomach (fundus) is wrapped around the lower part of the oesophagus. It can be done differently, including Nissen Fundoplication (360-degree and 360-degree wrap) and Toupet Fundoplication (270-degree / partial wrap).
Securing the Wraps: Sutures are used to secure the wraps, reinforcing the lower oesophageal sphincter (LES) and preventing acid reflux.
Closing the Incisions: The instruments and laparoscope are removed, and the incisions are closed with sutures or surgical tapes. Finally, sterling dressings are used to cover the closed incisions.

4.Recovery:

Depending on the types of surgery performed, you may be advised to stay in the hospital for a few days.

Healthcare providers will monitor you in the recovery room as the anaesthesia wears off.
Most patients can go home the same day or after a short hospital stay.
Doctors will recommend that you take a liquid diet initially, gradually transitioning to soft foods and then regular foods as tolerated.
You will also be advised to avoid heavy lifting and strenuous activities for a few weeks.

Follow-up appointments are planned to monitor healing and ensure the surgery’s success.

FAQ

Is fundoplication required with hiatus hernia repair?

Under normal circumstances, patients undergoing hiatus hernia repair should have a fundoplication. The exceptions are the emergent cases associated the gastric necrosis or the patient in extremis. A complete fundoplication is preferable in patients with good motility, and MSA is a viable alternative.

How long after hiatus hernia surgery can I eat solid food?

After about four weeks, you should be able to eat a full range of foods. Doctors may advise continuing with small meals and between-meal snacks if necessary. Continue to chew all foods well.

When is fundoplication recommended?

If your symptoms for gastroesophageal reflux disease (GERD) remain consistent, then your gastroenterologist may recommend a fundoplication.

What happens if fundoplication fails?

You may experience the following:

Bloating
Abdominal distension
Early satiety
Nausea
Upper abdominal pain
Inability to belch
Inability to vomit

What is the full liquid diet after hiatus hernia fundoplication?

A full liquid contains anything on a clear-liquid diet. The clear drinks can include:

Water
Tea
Juices
Squash
Clear Soups

You can also eat ice cream as long as it is completely melted. Avoid fizzy drinks, alcohol and citrus juices.

What precautions should I take after hiatus hernia surgery?

Post Surgery:

Gently wash the incision area with soap and water daily
Avoid baths, pools, hot tubs
Stick to shower
Have a restricted diet to prevent your stomach from extending
Eat 4 to 6 small meals per day instead of big heavy meals
Avoid spicy and hard-to-digest foods

Does fundoplication stop vomiting?

Yes, the surgery will stop vomiting and acid reflux. However, it can also stop normal burping. The air can get trapped inside the stomach, leading to pain.

When can I eat solid foods after surgery?

You can start eating solid foods three weeks after surgery. If your surgeon approves, slowly add foods you normally eat, except bread and solid meats. Your surgery team will tell you when to add these foods.

How long after hiatus hernia fundoplication surgery can I start exercising?

You can walk as much as you want within days of surgery. You can also resume light jogging, cycling and swimming after a month of surgery. These guidelines ensure your body has enough time to heal and regain strength. You can moderately resume exercises, such as yoga, stretching, and other sports activities, post 3 months of surgery.

How do I sleep after fundoplication surgery for a hiatal hernia?

Doctors do not recommend sleeping on the stomach after the surgery. This position can hurt your spine and pressurise the hip area. It is best to sleep on your side or back.

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