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.
Transoral Incisionless Fundoplication (TIF)
For many patients suffering from heartburn with a small hiatal hernia, or even without evidence of a hiatal hernia, a new procedure has demonstrated remarkably good results with an operation which requires NO INCISIONS AT ALL. The Transoral Incisionless Fundoplication (TIF) procedure is performed in the operating room, under general anesthesia, through the mouth with the aid of a standard endoscope. The procedure takes about an hour, can be done as an outpatient, and has been shown to eliminate the need for anti-heartburn medications in up to 97% of patients. Patients may require preoperative endoscopy and radiographic studies to determine if they are candidates for this procedure. Individuals with moderate to large hiatal hernias require the traditional laparoscopic surgical repair.