GASTROESOPHAGEAL REFLUX (GERD) AND HIATUS HERNIA
GERD is a common problem and is extremely prevalent in the West. Patients with GERD suffer from heart burn, regurgitation of food, difficulty in swallowing and sometimes more severe problems such as haemetemesis ( bleeding from the oesophagus). Associated symptoms such as a chronic cough, asthma and recurrent respiratory infections are often present. These are called atypical symptoms of GERD.
The cause of GERD is an incompetent lower oesophageal sphincter(LOS). This is a valve like mechanism that prevents acid and food from moving up into the oesophagus. ( Fig 1)
A hiatus hernia is associated with a defective LOS in 50% of cases. Here the stomach moves up into the chest to varying lengths and this further weakens the LOS function.
GERD is diagnosed by an endoscopy which identifies the damage to the oesophagus(oesophagitis). Additional tests such as a manometry and a 24hr pH monitoring of the oesophagus are required to complement the diagnosis.
excellent long term results to patientsexcellent long term results to patients
Patients are in hospital for 48 to 72 hrs and are able to resume normal activity within a week. The operation is durable and medication to control reflux is not required.
Para oesophageal hernias almost always require operative intervention. The operation can be done by a laparoscopic technique, which is extremely beneficial to these elderly individuals who are prone to complications. The technique is somewhat similar to surgery for GERD with a few modifications.
A para esophageal hernia may require a prosthetic mesh to bridge a large defect in the diaphragm in addition to creating a valve, as in an operation for GERD. Recovery is quick and patients are home within 3 days
A hiatus hernia is associated with a defective LOS in 50% of cases. Here the stomach moves up into the chest to varying lengths and this further weakens the LOS function.
GERD is diagnosed by an endoscopy which identifies the damage to the oesophagus(oesophagitis). Additional tests such as a manometry and a 24hr pH monitoring of the oesophagus are required to complement the diagnosis.
excellent long term results to patientsexcellent long term results to patients
Patients are in hospital for 48 to 72 hrs and are able to resume normal activity within a week. The operation is durable and medication to control reflux is not required.
PARA-OESOPHAGEAL HERNIA.
This is a less common variant of a hiatus hernia but carries more serious consequences. In this variant the stomach rolls up into the chest through the opening in the diaphragm. The symptoms are different from GERD. Patients suffer from regurgitation, palpitation after food and often have anemia. These patients are also much older than those who have GERDPara oesophageal hernias almost always require operative intervention. The operation can be done by a laparoscopic technique, which is extremely beneficial to these elderly individuals who are prone to complications. The technique is somewhat similar to surgery for GERD with a few modifications.
A para esophageal hernia may require a prosthetic mesh to bridge a large defect in the diaphragm in addition to creating a valve, as in an operation for GERD. Recovery is quick and patients are home within 3 days
