Revisional hiatal hernia surgery for anti-reflux

Revisional hiatal hernia surgery for anti-reflux is a complex procedure aimed at correcting issues that persist or arise after an initial surgery to treat a hiatal hernia or gastro-oesophageal reflux disease (GORD). These procedures are generally required when a previous operation did not fully resolve symptoms, complications occurred, or there was a recurrence of the hernia.

What is a hiatal hernia?

A hiatal hernia occurs when a portion of the stomach pushes through the diaphragm into the chest cavity, often leading to symptoms such as heartburn, acid reflux, or difficulty swallowing. In some cases, a hiatal hernia can worsen gastro-oesophageal reflux, increasing the severity of reflux symptoms. When left untreated, it can lead to complications such as oesophagitis or Barrett’s oesophagus.

Why would revisional surgery be needed?

Revisional surgery may be necessary for several reasons:

• Recurrent hernia: After the initial surgery, the hiatal hernia may recur, causing the return of symptoms like acid reflux, heartburn and discomfort.
• Failure of the anti-reflux mechanism: If the original anti-reflux surgery, such as a fundoplication, did not work as intended, the patient might continue to experience reflux symptoms.
• Complications from the initial surgery: Scar tissue, incorrect placement of the repair, or issues with the oesophagus or stomach during the first procedure can lead to the need for revision.
• Persistent or worsening symptoms: Some patients might not achieve complete symptom relief after the first surgery and may continue to experience acid reflux, regurgitation, or chest pain.

What does revisional hiatal hernia and anti-reflux surgery involve?

Revisional hiatal hernia surgery involves re-repairing the hernia, re-establishing the correct anatomy, and addressing any failures in the previous anti-reflux mechanism. Depending on the patient’s condition, the surgeon may:

• Repair or tighten the diaphragm: This step is crucial to prevent the stomach from slipping back into the chest cavity.
• Redo or adjust the fundoplication: In cases where a fundoplication was performed, this may need to be corrected or redone to better control reflux.
• Remove or reposition scar tissue: This ensures that the stomach and oesophagus can move freely and function correctly.
• Consider alternative anti-reflux procedures: If a fundoplication is not suitable, other techniques may be considered, such as the Linx device or other forms of anti-reflux surgery.

What are the benefits of revisional surgery?

• Improved symptom control: For patients whose symptoms did not resolve after their first surgery, revisional surgery offers a second chance to improve quality of life by eliminating reflux, heartburn and chest discomfort.
• Repair of complications: Revisional surgery can address issues caused by the initial surgery, such as swallowing difficulties or recurrent reflux.
• Enhanced quality of life: By resolving ongoing symptoms, patients can return to normal activities without the need for long-term medication or constant discomfort.

What are the risks and recovery of revisional hiatal hernia and anti-reflux surgery?

Revisional hiatal hernia and anti-reflux surgery is generally more complex than the initial procedure due to scar tissue and altered anatomy from the previous operation. This can increase the risk of complications, such as infection, bleeding or difficulty swallowing. However, with modern surgical techniques, including minimally invasive approaches, the risks can be minimised, and recovery is often quicker than in traditional open surgery.

Most patients will stay in the hospital for a few days post-surgery and can expect a recovery period of several weeks. During this time, a modified diet will be necessary to avoid complications like bloating or difficulty swallowing.

Revisional hiatal hernia surgery for anti-reflux is a specialised procedure that, while it can carry some increased risks compared to the first surgery, it offers significant benefits in terms of symptom control and quality of life. If you’re experiencing persistent symptoms after hiatal hernia or anti-reflux surgery, consult a specialist to discuss the possibility of revision.