Surgical procedure steps for hiatal hernia repair
Nov 16, 2022
Source: Cainiu Health
Dr. Sun Shaolong
Introduction
After general anesthesia, a pneumoperitoneum is established for the patient, followed by creating four small abdominal incisions (0.5–1 cm each). A laparoscope is inserted to visualize and dissect the esophageal hiatus. By dissecting the esophageal hiatus, the herniated contents of the hiatal hernia that have protruded into the thoracic cavity are gently reduced back into the abdominal cavity. The esophageal hiatus is then repaired to its normal size.
Hiatal hernia surgery is a minimally invasive procedure performed under general anesthesia. The main approach involves reducing the herniated contents and repairing the enlarged esophageal hiatus to treat the condition. The primary surgical steps are as follows:
1. After induction of general anesthesia, pneumoperitoneum is established in the patient, which is typically the first step in any minimally invasive surgery. Only after establishing pneumoperitoneum can sufficient abdominal space be created, allowing clear visualization of the internal organs via laparoscopy.
2. Next, four small incisions (0.5–1 cm each) are made in the abdomen to insert the laparoscope and examine the esophageal hiatus. The type of hiatal hernia is assessed—whether it is Type I sliding hernia, Type II paraesophageal hernia, Type III large hernia, or Type IV mixed hernia.
3. Using the 0.5 cm and 1 cm incisions, laparoscopic instruments are introduced to dissect and free the esophageal hiatus. By mobilizing the hiatus, herniated contents such as stomach or bowel that have entered the thoracic cavity are gently reduced back into the abdominal cavity. The esophageal hiatus is then sutured and narrowed to its normal size.
4. For larger hiatal hernias, after primary suture repair, it is recommended to reinforce the area with a mesh to strengthen the esophageal hiatus and reduce the risk of recurrence.
5. After securing the mesh, a complete or partial fundoplication is performed based on the severity of the patient’s reflux and heartburn symptoms. The entire procedure usually takes about one hour.
