TREATMENT of HIATAL HERNIA/GERD/REFLUX ACHALASIA

Treatment of Hiatal hernia/GERD/Reflux Achalasia cardia – disease depends on the stage of the disease and also on whether medical treatment has been tried before or not.

Over the past two decades, the range of abdominal surgical procedures performed by minimally invasive (or laparoscopic) techniques has grown enormously. The vast majority of common conventional surgery in the abdomen is now carried out safely, quickly and efficiently through a number of small, relatively painless incisions. Surgery for gastroesophageal reflux disease GERD/hiatal hernia, ulcers and tumors of the stomach, complex procedures involving the gallbladder, bile duct and liver and segmental removal of the small intestine and colon for cancer, diverticulitis and inflammatory bowel disease (IBD) are now everyday occurrences under the care of the surgeons.

Dr Nitin Jha has been doing these foregut laparoscopic surgeries (TREATMENT OF HIATAL HERNIA/GERD/REFLUX ACHALASIA) since last 15 years

Many of these procedures can be performed on an out-patient basis, while others require one or more nights in hospital. The common feature shared by all of these procedures is short hospitalization, earlier return to normal activity and reduced pain. Long-term there is a lower incidence of hernia (known as ‘incisional hernia’), quite a common complication of the long incisions used in conventional surgery. Research results show that minimally invasive surgery causes fewer complications and overall is safer than conventional surgery in appropriately selected individuals.

The Role of the Esophagus and How its Disorders Affect Swallowing

The esophagus delivers liquids and food from the back of the mouth to the stomach. For most of its length as it passes through the neck and chest, its lining resembles skin, which does not secrete any fluid such as mucus. Over the years the esophagus is exposed to many corrosive substances such as acids, enzymes, and bile from the stomach, as well as anything swallowed from above. Ulcers of the lining of the esophagus may result from prolonged exposure to these substances, particularly in the lowermost part near the stomach.

The muscular wall of the esophagus has its own rhythmic action that actively squeezes food toward the stomach. This activity can be impaired (called dysmotility) and difficulty swallowing may result. Sometimes it is necessary to measure the motility of the esophagus by a test known as manometry. Long-standing reflux disease may lead to impaired motility.

Minimally invasive surgery is used to treat many disorders of the esophagus including TREATMENT HIATAL HERNIA/GERD/REFLUX ACHALASIA & tumors.

Gastroesophageal Reflux Disease (GERD) Treatment

Gastroesophageal reflux disease (GERD), or reflux, occurs because of a failure of the normal mechanisms that protect the esophagus from the corrosive effects of acid and other stomach secretions. Long-standing reflux can cause ulceration, bleeding and eventually scarring of the lower esophagus. If lifestyle changes such as loss of weight, dietary modifications and sleep position do not produce acceptable relief from reflux, medications such as a Proton Pump Inhibitor (PPI) or an H2 Antagonist are usually prescribed. Although these drugs all reduce acid production in the stomach, there is no effect on the amount of stomach juice that refluxes, or corrosive components such as bile that it contains.

If symptoms require ever increasing doses of drugs, if long-term drug treatment is unacceptable of if complications such as stricture or bleeding have occurred, an anti-reflux procedure could be considered. Over the past two decades, laparoscopic anti-reflux surgery has emerged as the preferable surgical technique for such cases. Hospitalization is usually an overnight stay and return to work can occur in as little as a week.

Hiatal Hernia

A hiatal hernia is the protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm. Hiatal hernias often result in heartburn but may also cause chest pain or pain with eating. The most common cause is obesity. The diagnosis is often made by endoscopy or medical imaging.

Types

Sliding Hernia

This is the most common type type of hiatal hernia and occurs when the connection between the esophagus and the stomach “slides” up above the diaphragm, often dragging part of the stomach with it into the chest.

Paraesophageal Hernias

A paraesophageal hiatal hernia occurs when a portion of the stomach protrudes through the hole by which the esophagus passes through the diaphragm. The hernia then lies alongside the esophagus. Paraesophageal hernias tend to gradually increase in size leading to the protrusion of other abdominal organs into the chest.

Diagnosis

Because the hiatal hernia protrudes into the chest rather than abdominal wall, there is no visible bulge as with an abdominal hernia. Diagnosis of a hiatal hernia requires upper GI endoscopy, a barium swallow study, an MRI, or computerized tomography (CT) scan.

Symptoms

The most common symptom of hiatal hernia is reflux of gastric (stomach) contents into the esophagus, which can lead to chronic heartburn, one of the underlying causes of gastroesophageal reflux disease (GERD). In addition to heartburn and difficulty swallowing, some severe forms of hiatal hernia can lead to restricted blood flow to the stomach, a surgical emergency.

GIANT HIATAL HERNIA REPAIR –LAPAROSCOPIC

Treatment

For some patients, hiatal hernias are asymptomatic and require no treatment. Sliding hiatal hernias presenting with symptoms of GERD symptoms are typically treated with medications such as antacids, histamine-2 blockers and proton pump inhibitors (PPIs). For others, surgical repair may be indicated.

Surgery

For paraesophageal hernias and very large sliding hernias, surgical repair may be needed. Various minimally invasive techniques, notably a Nissen Fundoplication, are used to successfully treat these conditions.In video section– you can see other videos of our surgeries.

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TREATMENT of HIATAL HERNIA/GERD/REFLUX ACHALASIA

Achalasia Treatment

Normal swallowing requires the muscular valve at the entrance to the stomach (the Lower Esophageal Sphincter or LES) to relax to allow food and liquid to pass through. Achalasia occurs when this valve fails to relax. Difficulty swallowing liquids and solids, chest pain, and regurgitation are common symptoms of this disorder. In time, the esophagus becomes wider, thick-walled, and bent and loses its muscular contractions. The diagnosis is made with a combination of X-rays (a barium swallow or esophagram), endoscopy and esophageal manometry.

Treatment consists of defeating the action of the valve either by stretching (esophageal dilatation), or what is now considered the most definitive treatment, cutting of the muscle fibers of the valve. This treatment known as esophagomyotomy is performed by laparoscopic surgery.

Recently a novel procedure performed through the mouth known as Per-Oral EsophagoMyotomy or POEM has been developed in Japan to accomplish the same effect without surgery. No treatments can cure achalasia but the swallowing difficulties, regurgitation and chest pain can be markedly improved.