Paraesophageal Hernia Treatment | Pristyn Care

Risk Factors

Risk factors include:

• Obesity increasing intra-abdominal pressure
• Ageing (most common in patients over 60)
• Prior oesophageal or gastric surgery
• Connective tissue disorders
• Chronic constipation and straining
• Persistent heavy lifting or intense physical exertion

Who Is at Risk

Elderly patients over 60 with obesity, previous hiatal hernia surgery, chronic cough, or connective tissue disorders are at highest risk. Women are more commonly affected than men due to hormonal and anatomical factors.

Diagnosis

Diagnostic evaluation includes:

• Contrast swallow (barium) showing herniated stomach and GEJ position
• CT chest-abdomen to assess hernia size and organ involvement
• Upper GI endoscopy to assess mucosal integrity and Cameron lesions
• High-resolution manometry for GEJ pressure and oesophageal motility
• pH-impedance testing if significant GERD is suspected

Treatment: Laparoscopic PEH Repair

Pristyn Care performs laparoscopic paraesophageal hernia repair with reduction of herniated contents, excision of hernia sac, crural repair, biosynthetic mesh reinforcement, and Nissen or Toupet fundoplication.

Laparoscopic PEH Repair Procedure

Procedure involves:

• Laparoscopic approach with 5 ports
• Reduction of herniated stomach and organs into the abdomen
• Complete excision of the hernia sac from the mediastinum
• Mediastinal oesophageal mobilisation to achieve tension-free repair
• Primary posterior cruroplasty with non-absorbable sutures
• Biosynthetic mesh reinforcement of hiatus for large defects
• 360-degree Nissen or 270-degree Toupet fundoplication

After the Surgery

Post-operative care includes:

• Soft diet for 4-6 weeks to allow oedema resolution
• Avoidance of heavy lifting for 6 weeks
• Proton pump inhibitor therapy for 3-6 months
• Chest X-ray at 6 weeks to confirm hernia reduction
• Barium swallow at 3-6 months to assess fundoplication and recurrence
• Long-term endoscopic surveillance for Barrett’s oesophagus

Possible Complications of PEH Repair

Potential complications include:

• Recurrence of hiatal hernia (most common long-term issue, 10-20%)
• Dysphagia from tight fundoplication (usually temporary)
• Gas bloat syndrome
• Oesophageal or gastric perforation during dissection
• Pleural injury causing pneumothorax
• Mesh erosion into the oesophagus (rare with biosynthetic mesh)