Patients who suffer from chronic heartburn or gastroesophageal reflux disease (GERD) may have a condition called hiatal hernia. This is a dilatation of the normally occurring teardrop shaped opening in the diaphragm through which the esophagus passes from the chest into the abdomen to reach the stomach. The degree of dilatation and the resultant herniation of stomach through the dilatation are variable, as are the symptoms and treatment required. Patients who are unsuccessful in controlling symptoms with lifestyle changes and/or medications may be candidates for surgical correction of the hernia. Studies have shown that hiatal hernia repairs without the use of mesh can have a recurrence rate of 25-30% despite the fact that most of these recurrences are not associated with return of symptoms. Synthetic mesh products for use in this setting have been fraught with complications, however, due to scar formation around the esophagus, leading in some cases to erosion of mesh into the esophagus. Recent data suggests that the use of biologic mesh for these repairs is much better tolerated and carries much reduced risks of significant complications.
The repair of a hiatal hernia is performed laparoscopically, under general anesthesia, and usually requires only an overnight stay in the hospital. Patients are able to return to normal activities and work in 5-10 days.
Some patients may be a candidate for an implanted device which has been shown to have similar results in controlling heartburn and reflux. The LINX device is a “bracelet” of small magnets which is placed around the esophagus immediately before the stomach. This surgery can be performed as an outpatient in most cases.