Prof. Dr. Taner YİĞİT
General Surgeon
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General Information
A hiatal hernia is the displacement of the fundus—the widest part of the stomach located under the junction of the esophagus and the stomach—from its normal position in the abdomen, passing through the opening in the diaphragm where the esophagus passes from the chest cavity into the abdomen, and moving towards the chest cavity.
The classical symptoms of a hiatal hernia are:
Regurgitation of sour liquid into the mouth,
Burning sensation under the sternum in the chest,
Occasional dry cough (due to stomach acid irritating the throat).
Depending on the size of the hiatal hernia, these complaints may be mild and vague in some patients, or severe and excessive, significantly impairing the quality of life and eating/drinking habits in others. The cause of the symptoms is the malfunction of the valve mechanism between the esophagus and the stomach, which occurs as a result of the stomach herniating into the chest cavity. Due to this valve dysfunction, acidic fluids in the stomach escape from the stomach into the esophagus, causing irritation and burns (esophagitis), especially in the lower part of the esophagus. This irritation in the esophagus leads to the complaints listed above in patients. Prolonged and severe nature of these burns and irritation can lead to cellular changes called “Barrett’s esophagus” in the lower part of the esophagus, which is a precancerous condition.
The diagnosis of the disease is established through an upper gastrointestinal endoscopy based on your existing complaints.
In the treatment of hiatal hernia and related reflux complaints, medical treatment and surgical treatment options are available. Although medical treatment is partially effective in cases of small hernias and mild symptoms, it corrects the symptoms of the disease, not the disease itself. Medication does not correct the herniation in your stomach. Surgery is the definitive treatment method for patients who do not respond to drug treatment, have intense symptoms, or have severe irritation and burns in the esophagus on endoscopy. Surgery permanently treats the hiatal hernia and associated reflux complaints. After the surgery, the damage to the esophagus (Barrett’s esophagus and esophagitis) either improves or its progression is prevented, depending on the duration of the reflux and the severity of the burn and irritation.
Who is eligible for surgery?
Surgery is necessary for patients who have symptoms that cannot be controlled with medication, have a large hiatal hernia on endoscopy, have developed “Barrett’s esophagus” at the lower end of the esophagus, or have severe esophagitis (irritation and inflammation of the esophagus).
What preparations are required before surgery?
Standard procedures applied to patients who will receive general anesthesia before surgery are performed, such as blood tests (liver, kidney function tests, metabolic function tests, bleeding-coagulation status, etc.), a chest X-ray, and an anesthesiologist’s evaluation.
Our team will contact you shortly regarding your appointment details.
How is it done?
Reflux and hiatal hernia surgeries are currently performed as standard using laparoscopic surgery. In the operation, the herniated stomach is returned from the chest cavity to its standard location in the abdomen, and the enlarged esophageal opening in the diaphragm muscle is restored to its standard size and narrowed. Subsequently, the anterior wall of the fundus—the large area of the stomach—is rotated in front of the esophagus, and its posterior wall is rotated behind the esophagus and sutured together. This creates a wrap around the esophagus using stomach tissue to prevent stomach fluids from escaping into the esophagus by increasing the pressure in this area. This surgery is called “Nissen Fundoplication.”
What preparations are required before hospital admission?
Since your surgery is a surgical procedure to be performed on the digestive system:
It is safe to continue using the routine medications you must take, except for blood thinners, until the night before the surgery. Blood pressure medication and heart medication can be taken on the morning of the surgery with a small amount of water, at least 2 hours before the operation, with your doctor’s knowledge.
If you are using blood-thinning medications, you must warn your doctor about this and give your doctor time to stop these medications and start alternative ones instead.
If you smoke, it is absolutely necessary to quit smoking at least 1 week before the surgery or reduce it to the lowest possible level. This is a situation that will directly affect your lung performance after the surgery.
Generally, you should stop all solid or liquid food intake around 10-11 PM the night before the surgery, and you should be ready with at least 6 hours of fasting on the morning of the surgery.
Take a bath at home before being admitted to the hospital for the surgery. Remember that you will not have the opportunity to bathe for at least 2 or 3 days.
Do not wear nylon underwear when coming to the hospital. Nylon underwear can interact with some electrical devices used during surgery and cause skin burns.
It is useful to bring slippers, personal hygiene supplies (toothbrush, toothpaste, shaving kit, etc.), and sufficient underwear when coming to the hospital.
How long will I stay in the hospital?
Although your hospital stay is affected by many factors such as whether you were admitted the night before the surgery or on the morning of the surgery, how long your surgeon makes it a principle to keep the patient in the hospital after the surgery, and whether a surgical problem has developed after the surgery, it is generally about 1-2 nights.
What will happen during my stay in the hospital?
If you were admitted to the hospital the night before the surgery, you should use a protective blood thinner in the hospital. If you are admitted on the morning of the surgery, you should use it at home. This treatment will be planned and administered by your doctor. Be sure to use the toilet before going down to the operating room on the morning of the surgery. The time between being taken from your bed for the surgery and returning to your bed will generally be a time frame of about 2-3 hours.
This entire period is not the time spent on the surgery; the pre-operative preparation period in the operating room, your surgery, and your awakening procedure after the surgery are included in this process. You will mostly be taken back to your bed on the floor after the surgery, and generally, intensive care is not needed after the surgery. The process in the days following the surgery is as follows:
Day of Surgery: Approximately 4-5 hours after returning to your bed, you are encouraged to get up for your first walk and take a small walk inside the room. All your treatments on the day of surgery are administered intravenously, and food intake is not permitted.
1st Day After Surgery: Today is the day you start feeding orally. You are given a breakfast of tea, cream cheese, and biscuits, and you start your day. You are allowed to consume as much liquid as you wish during the day, and you are provided with seedless soup at mealtimes. Drains are usually not placed in the surgical area during these operations. Patients can usually be discharged toward the evening of the day following the surgery. This period can sometimes extend until the 2nd day after the surgery day.
When can I start my normal life?
Your return to normal life is highly dependent on the job you do. If you work a desk job, you will be able to perform your job on the 2nd or 3rd day after being discharged from the hospital. However, the standard rest period for this job group is about 7-10 days. If you work a job that requires physical labor, you can rest for a period of 15-20 days and then return to work.
Our team will contact you shortly regarding your appointment details.