Hernia

In UK, hiatus hernia repar by itself is not frequently undertaken. Hiatus hernias are actually quite common in the population and frequently cause little or no problems. I guess it depends on the type and severity of your symptoms.

There are two types of hernia; the most common is the sliding (or type 1) hernia (95%) where some of the cardia (the part of the stomach directly connected to the oesophagus) has pushed through the hiatus (hole in the diaphragm) into the chest. The US guidelines say, "Repair of a type I hernia in the absence of reflux disease is not necessary."

Type 2, paraoesophageal (or rolling) hernia is when some of the fundus (top sac) of the stomach has rolled up through the hiatus beside the oesophagus.

US guidelines say, "All symptomatic paraesophageal hiatal hernias should be repaired" but "routine elective repair of completely asymptomatic paraesophageal hernias may not always be indicated. Consideration for surgery should include the patient’s age and co-morbidities."

Both types of hiatus hernia can result in reflux since they impair the functioning of the muscles of lower oesophageal sphincter and the diaphragmatic ligament.

Hiatus hernia repair by itself may not be permanent as the hernia can slide back.

If reflux is the problem, it's better to combine hiatus hernia repair with a fundoplication where the fundus is wrapped around the repositioned oesophagus (ie having repaired the hernia). Apart from effectively tightening the lower oesophageal sphincter, the bulk of the wrap stops any reherniation through the hiatus.

Whether to have a fundoplication (which automatically includes hiatus hernia repair) is probably best summed up by this conclusion of a study of patients followed for 20 years after having had Laparoscopic Nissen Fundoplication: "95 per cent of patients confirmed they would have the operation again knowing what they know now." and another 20 year follow up study concluded: "Long-term results from the early experience with LNF are excellent with 94 % of patients reporting only occasional or fewer reflux symptoms at 20-year follow-up."

I personally had a LNF and it gave me my life back.

 

Hi David    Is it a hiatus hernia you are having? Not sure of test you mention,did it involve swallowing horrible liquid? Although its over a year since my last op I am having a hernia op again in 2weeks.This one is major surgery and have read risks but still having as its affecting my way of life.Very breathless as hernia pressing against lungs. Some hernias can be left alone if no problems but I would be guided by consultant.They do not advise surgery unless you really need it.Feel free to ask any questions  Best wishes  May

Hi David I'm in the same boat as you be a bit further along I had a pre-op in February having decided to go for the operation good old NHS as it is I'm still waiting and the longer it takes the more doubts I've got. I have a weak oesophagus and am having a partial op a 180 wrap as the surgeon fears a full 360 will leave me struggling to swallow. Do you get phlegm at night I get that and a blocked nose having to use nasal drops for over 12 months I've been told that is a symptom of stomach acid.