Natalie from Houston sent us this question: Do you recommend fundoplication in a patient with severe esophageal dysmotility and a paraesophageal hiatal hernia? Or is repairing the hernia the best that can be done? Dear Natalie, Your question is common and quite relevant. Why add a fundoplication...
I read with great interest the new study “Patient-Centered Outcomes after Laparoscopic Paraesophageal Hernia Repair” by Ujiki et al published in the current issue of JACS (Journal of the American College of Surgeons). 314 patients who underwent laparoscopic hiatal hernia repair were prospectively followed between...
Hiatal hernia surgery requires complete phrenoesophageal membrane dissection and proper esophageal mobilization. The phrenoesophageal membrane and hernia sac must be dissected and completely resected to allow for circumferential esophageal mobilization. The esophagus must be dissected free of mediastinal adhesions until obtaining at least 3 cm...
C.M. is a 71-year-old patient with worsening GERD related symptoms of 30-year duration. After years of proton pump inhibitor therapy, she has stopped responding to medical treatment and decided to seek more effective GERD treatment options. An upper endoscopy with ambulatory pH testing showed a...
There is widespread belief that hiatal hernia repair and Nissen fundoplication are a last resort for GERD patients. Indeed, most primary care physicians and gastroenterologists do not refer a GERD patient for surgery until it is too late. GERD patients are typically subjected to escalating...
Nissen fundoplication with hiatal hernia repair is the most reliable and most effective treatment of GERD or acid reflux disease. The procedure is also very safe with less than 1% complication rate. Gastroparesis or delayed gastric emptying is a poorly understood medical disorder. Gastroparesis results...
The diaphragmatic hiatus is a dynamic structure. It contracts and relaxes with every breath you take and dilates with every swallow. Supporting this moving structure is a thin layer of fibrous tissue called the phreno-esophageal membrane, PEM. PEM is an extension of both the endo-thoracic...
Hiatus means gap in Latin. The hiatus is the gap or opening in the diaphragm (breathing muscle) through which the food pipe (esophagus) passes from the chest into the abdomen. The hiatus is normally wide enough to allow food going through the esophagus to pass...