The term hiatal hernia refers to the condition where part or even all of the stomach resides in the chest cavity (thorax) instead of the abdominal cavity (abdomen). This can be caused by a combination of factors, including a large defect in the opening in the diaphragm (crural orifice) and shortening of the oesophagus itself (either congenitally, or a consequence of reflux disease), causing the stomach to migrate upwards.
The operation to correct this problem is aimed at returning the stomach back into the abdomen and keeping it there. This is usually possible by keyhole surgery, utilising four or five small incisions in the abdomen. The stomach is brought back into the abdomen, the sac containing it excised, and the crural orifice repaired. In the case of large defects, a biosynthetic mesh is used to aid this repair. If the oesophagus is found to be short, a lengthening procedure is used, by forming a gastroplasty (vertical incision into the stomach). This creates a neo-oesophagus , and the freed portion of stomach is used to create a wrap around the oesophagus. In this way, upward tension on the stomach is removed, preventing recurrent herniation.
Hospital stay is usually 2-4 post-operative days
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