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Hiatal hernia surgery in Tijuana
Laparoscopic repair of the diaphragmatic hiatus and anti-reflux fundoplication, for reflux disease that medication no longer controls or that has already caused damage.
What a hiatal hernia is, and what it has to do with reflux
The hiatus is the opening in the diaphragm through which the oesophagus passes to reach the stomach. When that opening widens, a portion of the stomach rises into the chest: that is a hiatal hernia. As the junction between oesophagus and stomach displaces, the natural mechanism that stops gastric contents rising is lost.
The result is gastro-oesophageal reflux disease: burning behind the breastbone, acid regurgitation, chronic cough, morning hoarseness, a sensation of a lump in the throat and, in some cases, chest pain mistaken for a heart problem. Not every hiatal hernia produces reflux, and not all reflux is due to a hernia: which is why the work-up matters.
When to operate, and when not to
Most patients with reflux are well controlled with proton-pump inhibitors and changes of habit: losing weight, eating dinner early, raising the head of the bed, stopping tobacco. While that works and there is no damage, there is no surgical indication.
Surgery is considered in four scenarios: when symptoms are not controlled despite properly conducted treatment; when the patient does not want or cannot depend on lifelong medication; when complications already exist — severe oesophagitis, stricture, Barrett's oesophagus; and when the hernia is large or paraoesophageal, with a risk of gastric volvulus. Before scheduling, endoscopy is needed and, depending on the case, motility studies and pH monitoring.
How the fundoplication is done
Laparoscopically, the herniated stomach is reduced into the abdomen, the distal oesophagus is mobilised to leave a sufficient intra-abdominal segment, and the hiatus is closed with sutures — with mesh in selected large defects. The valve is then built: the fundus of the stomach is wrapped around the oesophagus and fixed.
The wrap may be complete (Nissen, 360°) or partial (Toupet, 270°, among others). The choice depends on the patient's oesophageal motility: a complete wrap on an oesophagus that propels poorly produces difficulty swallowing. That is exactly why functional studies are requested before surgery and not after.
What the procedure involves
When it is indicated
- GERD not controlled by properly conducted medical treatment
- Long-term dependence on proton-pump inhibitors
- Severe oesophagitis, peptic stricture or Barrett's oesophagus
- Large paraoesophageal or mixed hiatal hernia
- Reflux with respiratory manifestations: chronic cough, laryngitis, difficult asthma
- Anaemia from chronic bleeding associated with the hernia
Techniques and resources
- High-definition laparoscopic tower
- Advanced energy sealing devices
- Biological or synthetic mesh for large hiatuses
- Oesophageal calibration bougie
- Intraoperative endoscopy where required
Frequently asked questions about hiatal hernia surgery
That is precisely one of the goals of fundoplication, and in many patients it is achieved. That said, it is not promised: a proportion of patients need to resume long-term treatment, especially where uncorrected factors such as overweight remain. Realistic expectations are discussed before surgery.
Some difficulty swallowing is expected during the first weeks, because there is inflammation around the valve. That is why the diet progresses from liquids to soft foods and then to solids. If the difficulty persists beyond that period it is investigated; sometimes a dilatation resolves it.
That is an important conversation. In patients with obesity, reflux improves with weight loss, and in some cases the indicated procedure is not a fundoplication but bariatric surgery that solves both problems. The joint assessment is made in the consultation.
Bring your studies and settle the question
One consultation with your ultrasound or CT in hand is worth more than ten internet searches. Book by phone or through the form and you will be told what is there, what it means and what your options are.