English      Portuguese

Bariatric surgery    Laparoscopic incisional hernia repair Laparoscopic cholecystectomy Laparoscopic antireflux surgery an haitus hernia repair Laparoscopic groin hernia repair Chronic constipation and pelvic floor disorders

LAPAROSCOPIC ANTIREFLUX SURGERY AND HIATUS HERNIA REPAIR.

Reflux across the valve between the stomach and the oesophagus is common.The presence of a hernia through the hole in the diaphragm may make the reflux worse by weakening the valve.It may also cause symptoms of its own.The symptoms of reflux may adversely affect our quality of life and cause complications in the future.

SYMPTOMS

- Heartburn
- Regurgitation
- Chronic cough from aspiration into the voicebox and lungs
- Difficulty swallowing.
- Epigastric pain
- Chest pain
- The hernia itself may cause retrosternal pressure or even twist in the chest if large enough.

DIAGNOSIS

The best way to assess the upper gastrointestinal tract is by endoscopy where a flexible
Light source and lens is used to visualize the upper GIT.This is a very pleasant procedure when done by a specialist with the correct equipment and sedation.
Barium studies have a role where the oesophagus is too narrow to allow the endoscope to pass.
Special studies with Ph sensor may be required and motility may also be checked.

COMPLICATIONS

- Bleeding
- Narrowing
- Predisposition to cancer formation

TREATMENT

- Medical; change in lifestyle and medication to decrease the acid secretion .
- Surgical; A new valve is constructed between the stomach and the oesphagus by means of
  laparoscopy.The diaphragmatic defect is also repaired. 
- Laparoscopy is done via 5 small incisions on the abdominal wall.This eliminates the pain and
  cosmesis of a long incision.
- Theater time is usually an hour and hospitalization is 3 days.
- Recovery is swift and return to work will be 2 weeks and active exercise 6 weeks.
- A special diet will need to be followed for a month and weight loss of 5-8 kgs can be expected.

COMPLICATIONS OF SURGERY

- Surgery is well tolerated and complications very uncommon.
- Difficulty with swallowing is very common early postop period but very seldom a long term
  problem.
- Bleeding for port site or organ
- Bowel injury
- Deep vein thrombosis and embolus
- Hernia at port site and uncommonly at the diaphragm.
- Infection at wound or in the abdomen very uncommon but may occur.