HERNIA REPAIR, HIATAL-

General Information

DEFINITION--Closure of a hiatal hernia, an abnormal weakness or opening in the diaphragm.

BODY PARTS INVOLVED--Lower esophagus; diaphragm; upper part of stomach.

REASONS FOR SURGERY

• Relief of painful symptoms.
• Prevention of the stomach from shifting upward into the chest cavity.
• Prevention of the stomach from spilling digestive acid into the esophagus, causing infection, pain and scarring.

SURGICAL RISK INCREASES WITH

• Adults over 60.
• Newborns and infants.
• Obesity or poor nutrition.
• Smoking.
• Recent or chronic illness.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.
• Alcoholism or use of mind-altering drugs.

What To Expect

WHO OPERATES--General surgeon.

WHERE PERFORMED--Hospital.

DIAGNOSTIC TESTS

• Before surgery: Blood and urine studies; x-rays of chest and upper gastrointestinal tract; ECG; endoscopy (See Glossary for both).
• After surgery: Blood studies.

ANESTHESIA--General anesthesia by injection and inhalation with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION

• An incision is made in the abdomen or the chest.
• The hernia in the diaphragm is located and closed with sutures.
• The top of the stomach is wrapped around the lower part of the esophagus and sutured in place.
• Sometimes, the vagus nerve is removed to reduce the amount of acid the stomach produces.
• The skin is closed with sutures or clips, which usually can be removed about 1 week after surgery.
• Laparoscopic repair is now available for some patients (see Laparscopy in Surgery section).

POSSIBLE COMPLICATIONS--Excessive bleeding or surgical-wound infection.

AVERAGE HOSPITAL STAY--5 to 7 days.

PROBABLE OUTCOME--Expect complete healing without complications. Allow about 6 weeks for recovery from surgery.

Postoperative Care

† Move and elevate legs often while resting in bed to decrease the likelihood of deep--

vein blood clots.

• Bathe and shower as usual. You may wash the incision gently with mild unscented soap.

† You may use non--prescription drugs, such as acetaminophen, for minor pain.

† To help recovery and aid your well--

being, resume daily activities, including work, as soon as you are able.

• Avoid heavy lifting for 6 weeks after surgery. Learn proper body mechanics to avoid strain contributing to recurrence and to prevent incisional hernia. > Avoid vigorous exercise for 6 weeks after surgery. Resume driving 5 weeks after returning home. > Don't strain with urination or bowel movements.

DIET--Clear liquid diet until the gastrointestinal tract begins to function again. Then eat a well--balanced diet to promote healing. Avoid coffee, tea, cocoa, cola drinks, alcoholic beverages and any food or spice that aggravates symptoms.

Call Your Doctor If

† Pain, swelling, redness, drainage or bleeding increase in the surgical area.

• You develop signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.
• You experience nausea, vomiting, constipation, difficulty in swallowing or abdominal swelling.
• You vomit blood or have black, tarry stools.