Recurrence or Dysphagia after Hiatal Hernia Surgery

Recurrence or Dysphagia after Hiatal Hernia Surgery

Thirty-six patients with hiatal hernia underwent surgical treatment. Nine (25%) were male and 27 (75%) were female. Of these thirty-six patients, thirty-three cases (91.6%) were primarily treated by the authors. Three (8.3%) patients had previously undergone laparoscopic hiatal hernia repair at other hospitals and they experienced recurrence (n = 2) or postoperative dysphagia (n = 1). To prevent recurrence of hiatal hernia hiatal suturing, omentectomy, fundoplication, suture traction from the esophagogastric junction to the abdominal wall to the proximal part of the linea alba to ensure at least 2–3 cm of esophagus is preserved below the diaphragm were used and mesh was used if the tissue at the hiatal crus was weak. To avoid overly tight sutures, esophageal bougie was used to guide the surgery and prevent postoperative dysphagia.
All thirty-six patients underwent laparotomy hiatal hernia repair (n = 33) or corrective surgery (n = 3). Six patients also underwent surgery for other surgical conditions and one underwent subsequent surgery. Twenty-six patients with isolated hiatal hernia underwent hiatal repair. The average operation time was 88.8 minutes (range 50 to 148 minutes). The hospital stay was 7.28 days (range 1 to 24 days). Of the thirty-three patients who underwent the first surgery, one experienced recurrence (3%). The remaining three patients had previously undergone surgery at another hospital and experienced a recurrence of hiatal hernia or dysphagia but all achieved satisfactory results after corrective surgery by the authors.
Patients with hiatal hernia are typically older, often have other health problems and their tissues may be fragile. Surgical repair must avoid a recurrence of hiatal hernia or postoperative dysphagia. Patients must resume a normal diet and resume activities that previously induced nausea. They must avoid nausea-inducing exercises (lifting objects heavier than 1.8–2 kg), maintain an anti-reflux posture (bed rest, do not lie flat immediately after meals) and control weight, exercise, alcohol consumption and food intake. Choosing an appropriate partial fundoplication and using an artificial esophagus also reduces the risk of nausea. Patients were closely monitored for symptoms of dysphagia and esophageal motility was performed as needed.