Hiatal Hernia and Anti-Reflux Surgery

What is it?

This type of surgery is done in order to repair a hiatal or paraesophageal hernia and/or to reduce symptoms of heartburn by preventing acid from refluxing up from your stomach into your esophagus (swallowing tube).

Why?

You have a hernia and/or gastroesophageal reflux (heartburn). The heartburn is due to a defective valve (sphincter) at the lower end of your esophagus. This surgery repairs the hernia and tightens this sphincter to decrease the amount of gastroesophageal reflux.

Preoperative Evaluation

This surgery is a common procedure. You will need to undergo several tests before surgery in order to make the procedure as safe as possible. Some of your investigations may include:

Prior to your surgery, you will be assessed in the Pre-Admission Clinic at London Health Sciences Centre Victoria Hospital, located in Zone C Level 2, Room C2-600.

Before Surgery

DO NOT EAT OR DRINK ANYTHING, including water, after midnight the night before the procedure unless instructed otherwise by your surgeon. Leave jewellery and other valuables at home. Stop smoking for a least 2 weeks before your surgery.

Procedure

The procedure is often done 'laparoscopically' through five small (1.5 cm) cuts (incisions) in your abdomen. The video camera and special instruments are then inserted through the incisions to do the repair. You may undergo a "Nissen" Hiatal Hernia procedure where the stomach is wrapped around the lower end of the esophagus to tighten up the sphincter.

Occasionally, the surgeron is unable to do the procedure lalaroscopically and must convert to open surgery in order to make it safer for you. In this case, you will have an incision in the middle of your abdomen and your recovery will be longer.

To help prevent blood clots from forming in your legs during and after surgery, sequential compression stockings may be applied.

Time

The procedure takes 2 to 4 hours and is done in the Operating Room at Victoria Hospital.

Risks

As with all surgery there are risks. Some of these include bleeding, infection, leaks, heart attack, irregular heartbeats, stroke, blood clots to the lung, and sometimes death.

After Surgery

You will wake up in the Post Anesthesia Care Unit (PACU or 'recovery room'). A breathing tube may be in your mouth to help with your breathing. Once you are awake and able to breathe on your own, the breathing tube will be removed and you will be transferred to the Thoracic Observation Unit in Zone C Level 5.

You will have one or more tubes. They will be coming from your nose (nasograstic), bladder (catheter), and/or arm (intravenous). The tubes will be removed over the next 1-2 days.

Family and Friends

Family and friends may wait in the waiting area in the Perioperative Care Waiting Room. Your surgeon will come to speak with them following your surgery.

Pain

There is moderate pain with this surgery. You may have a Patient Controlled Analgesia (PCA), an intravenous that you control to give yourself the medication when needed.

Discharge

Once you are eating a regular diet you will be ready to go home. The average length of stay is 1 to 2 days (3-4 for open procedure). You must go home with either a friend or relative by private vehicle or by taxi, NOT by public transportation. You will not need home care support.

Dressings

Bandages will cover the sites where the instrument incisions were. This bandage should be kept dry and left in place for 2 days. After 2 days, remove the bandage and gently wash the wound with a mild soap in the shower. The incisions may be stapled closed or covered with paper tapes (steri-strips). If the incisions are stapled, arrangements will be made to have the staples removed by your family doctor in about one week. The paper tapes help with healing and will fall off in a few days. Further dressings are not needed, but you may cover the wounds with dry gauze if there is any drainage from them.

Diet

You should eat a soft diet for 2-3 weeks following surgery. You may find that some solid foods will stick when swallowed. Mild sticking is normal and should resolve in a few weeks. If you have sticking, try a liquid diet. If this does not improve in a few days, call your surgeon's office.

Activity

You are encouraged to do your regular activities except:

No heavy lifting for 4 weeks

Prescriptions

You will likely be given a prescription for pain medication and a stool softener to prevent constipation. Additional prescriptions may be given if needed.