Medium size hernia
When the hilum is 3–5 cm, the esophagus is shortened and “goes” upward - the surgeon mobilizes it in the mediastinum until it reaches 2–3 cm of the abdominal region without tension (a condition for a lasting result), brings the diverged legs of the diaphragm together with interrupted sutures and forms a cuff. It is with such hernias that erosive esophagitis and anemia from hidden bleeding are more common - surgery eliminates both the cause and the symptoms. Recovery: soft diet for 3 weeks, restriction of heavy lifting for 6 weeks, control gastroscopy after 2–3 months.
Indications
- hiatal hernia with reflux not controlled by medications;
- GERD with long-term dependence on omeprazole, night reflux, regurgitation;
- extraesophageal manifestations of reflux: laryngitis, cough, asthma-like attacks;
- Barrett's esophagus, erosive esophagitis - according to indications;
- large paraesophageal hernias with a risk of gastric strangulation.
The essence of the Nissen operation
The stomach is brought down from the chest cavity, the legs of the diaphragm are sutured behind the esophagus (removal of the hernial orifice - crurorrhaphy), and the fundus of the stomach is wrapped around the lower esophagus 360°, creating a cuff - a new valve that restores the barrier against reflux. Laparoscopic execution through 5 punctures is the standard: heartburn disappears in 90–95% of patients, the majority refuse medications forever. The size of the hernia determines the complexity: with large hiatal hernias, the stomach and other organs are returned from the mediastinum, and a wide defect is sutured (sometimes with a mesh).
Benefits of laparoscopy
Laparoscopic access is the standard of modern abdominal surgery: instead of a 10–20 cm incision, 3–4 punctures are left, the pain after surgery is much less, the patient gets up on the day of surgery and is discharged after 1–2 days, the risk of wound infection, hernias in the scar and adhesions is several times lower, and the enlargement of the camera allows you to operate more accurately. In the clinics below, operations are performed by surgeons with extensive laparoscopic experience; hospital (SKD) is included in the price according to the price list.
