Laparoscopic Hiatus Hernia Repair
This operation is performed under a general anaesthetic. Firstly the abdomen is inflated with carbon dioxide gas through a laparoscopic port placed through a small incision, through which a laparoscope (camera) is placed. Then 4 other small incisions are placed, a special metal bar is placed to retract the left side of the liver upwards to see the hiatus, and graspers and other instruments are placed through the other ports. The contents of the hiatus hernia are reduced if possible, and the lining tissue of the hiatus hernia (called the hernial sac) is separated from the structures in the chest and the sac and contents of the hernia are progressively brought back down into the abdomen. The oesophagus is encircled with a Nylon tape to help move it from side to side, and it is freed from some of the tissues in the chest, to allow the gastro-oesophageal junction (GOJ) to sit in the abdomen without tension. Then the muscle tissue surrounding the hiatus (the crural pillars) are sutured together to narrow the size of the opening in the diaphragm. This may be reinforced with mesh (prosthetic material). Further sutures are placed to reconfigure the normal anatomy of the GOJ. Depending on the case, a fundoplication (wrapping the top of the stomach around the oesophagus) may be performed. The Nylon tape, metal retractor are then removed, the carbon dioxide gas is released from the abdomen, and the wounds are closed with sutures.