Laparoscopic Hiatal Hernia Surgery

A hiatal, or diaphragmatic, hernia occurs when the lower part of the esophagus and a portion of the stomach slide up through the esophageal hiatus, an opening in the diaphragm through which the esophagus passes before it reaches the stomach. In a small percentage of cases, the junction of the esophagus and stomach remains in place, but a portion of the stomach rolls up and through the esophageal hiatus alongside the esophagus.

Histal hernias are repaired using a procedure known as Nissen fundoplication, which is surgery to repair a bulging (herniation) of stomach tissue through the muscle between the abdomen and chest (diaphragm) into the chest (hiatal hernia).

When the opening (hiatus) in the muscle between the abdomen and chest (diaphragm) is too large, some of the stomach can slip up into the chest cavity. This can cause heartburn (gastro-esophageal reflux: GER) as gastric acid backflows from the stomach into the esophagus. GER can, over many years, damage the mucosa of the esophagus and in a minority of cases, is thought to lead to cancer of the esophagus.

This may be performed laparoscopically. In a laparoscopic fundoplication, small (1 cm) incisions are made in the abdomen, through which instruments and a fiberoptic camera are passed. The operation is performed using these small instruments while the surgeon watches the image on a video monitor. Laparoscopic fundoplication results in less pain and shorter hospitalization times than the open operation.

While the patient is deep asleep and pain-free (general anesthesia), the stomach and lower esophagus are placed back into the abdominal cavity. The opening in the diaphragm (hiatus) is tightened and the stomach is stitched in position to prevent reflux. The upper part of the stomach (fundus) may be wrapped around the esophagus (fundoplication) to reduce reflux.

Patients may need to spend 3 to 10 days in the hospital after surgery.

Procedures
  A. General Surgery
    1. Laparoscopic Surgery
      a. Exploratory
      b. Appendix
      c. Hernia
      d. Gallbladder
      e. Colon
      f. Hiatal Hernia
    2. Conventional Surgeries
      a. Hernia Repair
      b. Colon
      c. Stomach
      d. Appendix
      e. Thyroid
      f. Soft Tissue Masses and Skin Lesions

  B. Vascular Surgery
    1. Repair of abdominal aortic aneurysm (AAA)
    2. Bypass surgery of extremities
    3. Carotid endarterectomy (CEA)
    4. Creation of arterio-venous fistulas
    5. Placement of central lines

  C. Varicose Vein Treatment
    1. TIPPS (Trans-Illuminated Powered Phlebectomy)
    2. SEPS (Subfascial Endoscopic Perforator Surgery)
    3. Deep venous thrombosis

  D. Breast Disease Management
    1. Evaluation of breast lumps (solid or cystic)
    2. Cyst aspirations
    3. Fine-needle aspiration of solid breast lump
    4. Stereotactic breast biopsy
    5. Sentinel lymph node biopsy
    6. Conventional biopsy
    7. Lumpectomy
    8. Mastectomy

  E. Gastric Bypass (Bariatric Surgery)

  F. Wound Management and Treatment

  G. Thoracic surgery
    1. Chest tube placement
    2. Removal and biopsy of nodules in lung and mediastinum
    3. Lobectomy

  H. Vascular Laboratory