A 32-year-old gentleman, presented to Aster Hospital, Mankhool with a prolonged history of heartburn, upper abdominal pain, disturbed sleep due to regurgitations for more than two years. He was being treated – for ‘acidity’ by various doctors. His upper GI endoscopy revealed that he had a hiatus hernia and esophagitis. He always responded well to anti-reflux medications and Proton Pump Inhibitors, but his symptoms recurred as soon as the medications were stopped. On further evaluation by pH studies and esophageal manometry, he was offered laparoscopic surgery as a long-term solution for his reflux. The patient underwent a Laparoscopic Hiatoplasty and Nissen ‘s fundoplication. He has fully recovered now and no longer has reflux symptoms. He does not require any medications now.
Hiatus hernia refers to migration of part of stomach into the chest cavity causing a person 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. Patients of hiatus hernia and GERD typically present with heartburns, burping, and upper abdominal pain. Sometimes they can present with chronic cough due to stomach contents entering trachea. They can atypically be present with backaches and bad breath. ·
An upper GI endoscopy can demonstrate hiatus hernia and changes of esophagitis. These can range from early lower esophagus erosions to Barrett’s esophagus. Long-term complication is carcinoma of esophagus due to long-term damage to the esophageal mucosa. The patients ‘are further evaluated with pH studies and esophagus manometry. Once proven GERD, medical management includes long-term PPI’s and prokinetics.
Laparoscopic surgery is one option for patients’ who are young and require long-term medications, patients with severe changes in the lower esophagus, patients with non-acid reflux who do not respond to PPI’s.
Laparoscopic Hiatoplasty and fundoplication is a minimal invasive surgery which involves restoring the intra-abdominal length of esophagus by reducing the hiatus hernia, tightening the hiatus by approximating right and left crurae and 360 degree wrap of fundus around lower end of esophagus. Surgery is done under general anesthesia and hospital stay is 24 hours. Patient resumes normal life in 8-10 days. Advantages of surgery are; no dependence on medication, long-term control of symptoms, early return to normal activities of daily living and prevention of reflux thereby preventing ongoing damage to the esophagus.
Specialist General & Laparoscopic Surgeon
Aster Hospital, Mankhool