CASE OF HIATUS HERNIA WITH ESOPHAGITIS

A 58-year-old woman presented to Aster Hospital, Mankhool with a prolonged history of nearly 20 years of heartburn, upper abdominal pain and disturbed sleep due to regurgitation. She was being treated – for ‘acidity’ by various doctors and she always responded well to anti-reflux medication and Proton Pump Inhibitors, but her symptoms recurred as soon as the medications were stopped. The symptoms were so severe that food used to regurgitate in her mouth if she laid down after food intake. She could not sleep in flat position and used to get up coughing very badly due to reflux. An endoscopy revealed a Hiatus Hernia with Esophagitis and on further evaluation she was offered Laparoscopic Surgery as a long-term solution. Dr. Abhay Khadke administered a Laparoscopic Hiatoplasty and Nissen’s fundoplication on the patient, who has now fully recovered with no trace of reflux symptoms and no need for medication.

Hiatus Hernia refers to the migration of a part of the stomach into the chest cavity causing the individual to be prone to GERD. GERD also is caused due to weakness of the lower esophageal sphincter allowing stomach contents to reflux in the esophagus. Hiatus Hernia and GERD patients typically complain of heartburn, constant burping, and upper abdominal pain. Sometimes they can present with chronic cough and atypically with backaches and bad breath.

Laparoscopic Surgery is one option for patients’ who require long-term medication, patients with severe changes in the lower esophagus and for patients with non-acid reflux – who do not respond to PPIs. Laparoscopic Hiatoplasty and Fundoplication is a minimal invasive surgery which involves restoring the intra-abdominal length of the esophagus by reducing the Hiatus Hernia, tightening the Hiatus by approximating right x left crurae and a 360-degree wrap of the fundus around the lower end of the esophagus. The patient is operated under general anesthesia and is advised a hospital stay of 24 hours. The patient can resume normal daily routine in 8-10 days, post-operation. Following this procedure, the patient doesn’t have to depend on medication, is given a long-term solution for his/her symptoms, and can prevent reflux thereby preventing the ongoing damage to the esophagus.

Dr. Abhay Khadke
Specialist General & Laparoscopic Surgeon
MBBS, MS (General Surgery), MRCS