Expert Hiatus and Para-Oesophageal Hernia Surgery in Sydney

Hiatus or para-oesophageal hernia

• Hiatus hernia is a condition where the contents of the abdominal cavity herniate into the cavity.
• Risk factors: Obesity, can occur as a complication of fundoplication surgery and some familial conditions
• Complications: This could cause volvulus (twisting) of the stomach compromising its blood supply.

When to seek surgical help?

• Most are found incidentally on scans performed for some other reason. They need an operation if they are large, and cause symptoms or complications.
• Symptoms: Shortness of breath especially on exertion, difficulty in swallowing, abdominal pain and vomiting, and pressure on the heart causing a variety of symptoms, including those experienced in GORD.

What is the management of hiatus hernia?

• The management depends on the presentation, whether the patient presents emergently with severe symptoms or electively.
• In an emergent situation, the priority is to decompress the stomach with either a tube inserted via the nose or Gastroscopy. This may be followed by an operation to fix the hernia and possibly excise a part of the stomach if the blood supply was compromised.
• In an elective situation, the patient would undergo a thorough investigation including gastroscopy, CT scan and sometimes respiratory and cardiac investigation prior to operation.
• Hiatus hernia repair and fundoplication: This is a key-hole operation performed under general anaesthesia to reduce the hernia, tighten the junction between the oesophagus and stomach, and wrapping of the stomach around the lower part of the oesophagus to recreate a valve.

What to expect following the operation?

• Length of hospital stay depends on the presentation, ranging from 1-2 days to a week provided the recovery is uncomplicated.
• Return to light duties may be possible within a week although heavy lifting is recommended to be avoided for 4-6 weeks.