paraesophageal hernia repair surgery?

March 6, 2024 1:03 PM

Have you (or someone close to you) had a paraesophageal hernia repaired? This is not a question about the more usual hiatal or GERD surgery but specifically fixing a paraesophageal hernia (moving the stomach back into place from the chest.)

I would like to hear about it, how you chose a doctor, how long recovery took, if you had to travel for it and if so how long til you were able to travel back, any complications, anything else you wished you knew before you did it.

posted by anonymous to Health & Fitness (2 answers total)

For a minute I thought I'd posted this and forgotten that I had. I'm scheduled for paraesophageal hiatal hernia (PHH) surgery this coming Wednesday (sew up hole in diaphragm, mesh for support, Nissen fundoplication). I'm very interested in reading what other people have to say about this.

I had so few symptoms that PHH wasn't suspected at first. Maybe once a month in 2023 (and not even every month) I'd feel pressure in my upper chest after eating (usually breakfast, sometimes from eating late at night), and twice, two episodes of nausea. I have a great gastroenterologist and I would dutifully report what was happening when I saw him, usually every couple of months, for my Crohn's issues. But the upper chest pressure episodes were so rare, it was hard to see a pattern.

He had previously diagnosed me with hiatal hernia via EGD (the regular kind of HH usually treated successfully with PPIs, as was the case with me). I've since learned that paraesophageal hiatal hernias account for less than 5% of all HH. He asked me to see my primary care physician to rule out any heart issues. She ruled out heart issues in mid-November, and scheduled me for barium swallow tests. They showed that half to 2/3 of my stomach is in my chest. I sent the results to my gastroenterologist and he immediately saw me, and explained why this needed to be addressed sooner than later, due to the possibility of the stomach twisting, cutting off its blood supply, and requiring emergency surgery to repair. It's rare, but it does happen.

My GI asked me to schedule a consult with a surgeon he personally knew and who he has worked with (my PCP also asked that I schedule a consult.) This surgeon is experienced in laparoscopic and robotic-assisted surgery to repair PHH, at one of the Inova hospitals in Northern Virginia. My GI scheduled me for the earliest available EGD + colonoscopy, which I had last week; so, more images/data have been obtained and sent to the surgeon. In February I met with the surgeon, who has done hundreds of these types of surgeries, and he seems like someone I can work with. He has a good reputation as a DC-area "top doc." In terms of going with this particular surgeon, I relied very much on my gastroenterologist's opinion.

I have been debating since the diagnosis and surgical consult as to whether or not I should do this now, or wait. I spent a lot of time reading the hiatal hernia subreddit (and filtering as needed for paraesophageal). I also read articles from the National Library of Medicine, Mayo Clinic, and other reputable sources to learn as much as I could.
I decided to go ahead and do it now for the following reasons:
1. I'm in a rural area and I don't want to risk having emergency surgery rather than my being able to plan for it and having it done with my choice of surgeon, my choice of hospital, and on my schedule. My surgeon and hospital are about 100 miles away. I'm staying with a friend in the area the night before, and for a day or two after I'm released (hopefully, I'll need to stay at the hospital only one night). My brother or another friend will then drive me home, as I won't be able to drive for at least a week.
2. This was the fact that ultimately made me decide to proceed with the surgery: my grandfather had the exact same diagnosis (stomach 2/3 into his chest cavity) and he didn't have the surgery until he couldn't even eat a mashed-up banana. My aunts tell me that he did just fine afterwards, even though he had the traditional surgery rather than laparoscopic, which wasn't yet in use.
3. I'm in my late 60s, am not currently having Crohn's issues (which is rare for me), I'm in reasonably good health, and the combined opinion of my doctors is that having it now rather later is more prudent.
4. The sooner I get this over with, the sooner I can recover.

Things I'm not thrilled about:
1. Having surgery, period. Especially since I am not currently having symptoms. (The surgeon said that was often the case with PHH).
2. Post-surgery dietary restrictions: the liquids-then-pureed foods diet for something like two months, and having to be very careful when introducing foods back into my diet (because during the healing process, if you aren't careful, you can get food uncomfortably stuck in your esophagus.)
3. Reduction in stomach size which means I will have to eat much smaller/more frequent meals. Probably permanently. Weight loss of 10 to 15 pounds is likely--okay, great, but I'm not excited about the process of getting there.
4. Can't drink during a straw during recovery because of taking in air (and some people avoid straws completely thereafter). No carbonated beverages during recovery (and again, some avoid them afterwards). Likely cannot vomit again. Can't burp like before.
5. Restrictions on how much weight you can lift afterwards. (Some sources say for the first phases of healing, some say for a longer period of time.) I've slung 25 bags of potting soil around and will likely not want to do that anymore.

My refrigerator and pantry are well-stocked with "safe" post-surgical liquid and soft foods, and my blender is at the ready! All that is left for me is to see how things go after the surgery next week, and in the two months ahead. If the thread closes, feel free to MeMail me!
posted by apartment dweller at 3:09 PM on March 6, 2024 [2 favorites]

I had robotic paraesophageal hernia repair on 01/09. The surgeon characterized the hernia as ‘severe’ and was emphatic in advising that it be addressed sooner rather than later. My recovery has been spectacularly trouble free. I was admitted for an overnight stay and released the next day with six small superglued incisions. The first 24-32 hours were pretty uncomfortable. Much of that discomfort was simply the fun of being in the hospital and post anesthesia yuckiness. After discharge I took alternating dosages of ibuprofen and acetaminophen every 4 hours around the clock for 3 days. No further pain management/medication was required. I was on clear liquids for a week then liquids for another 10 days at which time the surgeon indicated that I could begin cautiously adding solids while avoiding rice, bread, and pasta. Following that I have slowly returned to a normal diet having completed that process just this week. I find that I must eat smaller meals or I get pretty uncomfortable. I have been super cautious re physical activity and exertion. I have felt perfectly normal since the 12-14 day mark so holding back on exertion feels unnatural. I am told to hold back on exercise/exertion until the 90 day mark. Other than that the surgeon has placed no further restrictions on me. I lost 13 lbs. in the process which is a change that was needed anyway. I can’t think of anything that I would do differently or better. I feel very lucky in that the whole thing has been so very easy compared to what I was led to expect. Feel free to memail if you like.

The last thing I remember before the surgery was asking the anesthesiologist if the robot was named ‘Robbie’. And of course I was out before he could answer.
posted by royboy at 4:45 PM on March 7, 2024 [1 favorite]