Large and paraesophageal hernias
Large hiatal hernias are dangerous not only due to reflux: volvulus and strangulation of the stomach in the chest cavity, anemia from erosions (Cameron's ulcers), compression of the lung and heart with shortness of breath and pain behind the sternum - therefore, surgery is indicated even with moderate symptoms. The surgeon removes the hernial sac from the mediastinum, lowers the stomach, restores the esophageal opening to a normal diameter (if the hilum is more than 5-6 cm and weak legs - strengthened with a lightweight mesh) and completes with fundoplication with fixation. Hospitalization for 2–3 days, X-ray control with contrast before discharge, diet according to the scheme for 4 weeks.
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.
