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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 at 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.

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