Robotic Hiatal Hernia Repair for Severe Heartburn
Question of the week from Reginald in Houston: I had surgery for hiatal hernia in 2014. I re-experienced reflux after 15 months and began taking Omeprazole. This seemed to work. In the last 4 months other symptoms have begun and my surgeon had me go for and Upper G.I. The surgeon says I have a slipped Nissen fundoplication. Next week I’m scheduled for a robotic surgery conversion from Nissen to Toupet fundoplication, possible gastropexy, possible EGD and redo hiatal hernia repair with possible mesh placement. How successful and durable is revision surgery? Will heartburn reoccur?
There is no difference in laparoscopic Nissen fundoplication and hiatal hernia surgery outcome when performed with or without a robotic platform. What determines heartburn surgery outcome are surgeon skills and experience as well as surgical technique. Slipped Nissen fundoplication shortly after primary repair is almost always secondary to poor esophageal mobilization. Slipped Nissen fundoplication is extremely rare in my practice at Houston Heartburn and Reflux Center.
I general, the success rate of Nissen fundoplication and hiatal hernia repair decreases after each revision. However, redo hiatal hernia and Nissen fundoplication surgery is particularly effective in the setting of poor prior esophageal mobilization. Conversion of Nissen to Toupet fundoplication is indicated if part of gastric fundus is resected during revision and there isn’t enough gastric fundus tissue to perform a loose Nissen fundoplication. In the majority of cases, a Nissen wrap can be redone without any difficulty or problem. I almost never use gastropexy unless patient has had history of gastric volvulus. Gastropexy does very little in terms of preventing hiatal hernia recurrence.
If revision surgery is properly performed, hiatal hernia repair and Nissen fundoplication are durable and heartburn is not likely to recur.