Laparoscopic Hiatal Hernia surgery in bangalore, Best Doctors,Cost in India

Hiatal hernia surgery in Bangalore, india & Cost of Hiatal hernia surgery

Dr Adarsh M Patil mbbs ms Is one of the leading surgeons in Bangalore.

15 years of experience in eminent hospitals like Manipal Hospital, Apollo Hospitals and Narayana Hrudalaya in Bangalore.

He has to experience of treating numerous hiatus hernia patients in Bangalore .

Call +91-9972446882 for Laparoscopic hiatal hernia appointment

What is Hiatal hernia ?

The distal esophagus normally is held in position by the phrenoesophageal membrane, a fusion of the endothoracic and endoabdominal fasciae at the diaphragmatic hiatus.

A hiatal hernia is present when a lax or defective phrenoesophageal membrane allows protrusion of the stomach up through the esophageal hiatus of the diaphragm.

Epidemiology of Hiatal Hernia

Hiatal hernia is the most common abnormality reported in upper gastrointestinal (GI) radiographic studies. An estimated 10% of the adult population in the United States has a hiatal hernia.

The condition occurs most commonly in women in their fifth and sixth decades. Most hiatal hernias are asymptomatic; however, an estimated 5% of patients with a hiatal hernia have symptoms related to persistent gastroesophageal reflux (GER) disease. Laproscopic Hiatal Hernia surgery in Bangalore.

The type of hiatal hernia is defined by the location of the gastroesophageal (GE) junction and the relationship of the stomach to the distal esophagus.

In type I or sliding hiatal hernia,

the phrenoesophageal membrane is intact but lax, thereby allowing the distal esophagus and gastric cardia to herniate through the esophageal hiatus and placing the GE junction above the diaphragm. This is the most common type and is usually asymptomatic.

A type II or paraesophageal hiatal hernia

occurs when a focal defect is present in the phrenoesophageal membrane, usually anterior and lateral to the esophagus, which allows a protrusion of peritoneum to herniate upward alongside the esophagus. The GE junction remains anchored within the abdomen, whereas the greater curvature of the stomach rolls up into the chest alongside the distal esophagus. Eventually, most of the stomach can herniate. Because the stomach is anchored at the pylorus and cardia, however, the body of the stomach undergoes a 180-degree organoaxial rotation, resulting in an upside-down intrathoracic stomach when it is herniated.

Type III represents a combination of types I and II.

This type is more common than a pure type II and is characterized by herniation of the greater curvature of the stomach and the GE junction into the chest.

A type IV hiatal hernia occurs

when abdominal organs other than or in addition to the stomach herniate through the hiatus. Typically, these hernias are large and contain colon or spleen in addition to the stomach within the chest.

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Symptoms and complications in patients with sliding hiatal hernia (type I)

hiatal hernias are related to GE reflux (GER; see Section II). Paraesophageal and combined (types II, III, and IV) hernias frequently produce postprandial pain or bloating, early satiety, breathlessness with meals, and mild dysphagia related to compression of the distal esophagus by the adjacent herniated stomach. The herniated gastric pouch is susceptible to volvulus, obstruction, and infarction and can develop ischemic longitudinal ulcers (termed Cameron ulcers) with frank or occult bleeding.

Diagnosis and evaluation of Hiatal hernia surgery in Bangalore

Chest x-ray. The finding of an air-fluid level in the posterior mediastinum on the lateral x-ray suggests the presence of a hiatal hernia. Differential diagnosis includes mediastinal cyst, abscess, or a dilated obstructed esophagus (as is seen in end-stage achalasia).
A barium swallow confirms the diagnosis and defines any coexisting esophageal abnormalities, including strictures or ulcers. It is the diagnostic study of choice. The positions of the GE junction and proximal stomach define the type of hiatal hernia.
Esophagogastroduodenoscopy (EGD) is indicated in patients with symptoms of reflux or dysphagia to determine the degree of esophagitis and whether a stricture, Barrett esophagus, or a coexisting abnormality is present. EGD also establishes the location of the GE junction in relation to the hiatus. A sliding hiatal hernia is present when greater than 2 cm of gastric mucosa is present between the diaphragmatic hiatus and the mucosal squamocolumnar junction.
Esophageal manometry to evaluate esophageal motility is warranted in patients who are being considered for Laparoscopic Hiatal Hernia surgery in Bangalore.

Laparoscopic Hiatal Hernia surgeon in Bangalore India

Management of Hiatal Hernia surgery

Asymptomatic sliding hernias require no treatment.

Patients with sliding hernias and GER with mild esophagitis should undergo an initial trial of medical management.

Patients who fail to obtain symptomatic relief with medical therapy or who have severe esophagitis should undergo esophageal testing to determine their suitability for an antireflux procedure (see Section II) and hiatal hernia repair.

Patients who do not experience reflux but have symptoms related to their hernia (chest pain, intermittent dysphagia, or esophageal obstruction) should undergo Laparoscopic Hiatal Hernia surgery in Bangalore.

All patients who are found to have a type II, III, or IV hiatal hernia and who are operative candidates should be considered for repair. The management of asymptomatic paraesophageal hernias is a controversial issue. Some surgeons believe that all paraesophageal hernias should be corrected electively, irrespective of symptoms, to prevent the development of complications. However, recent data suggest that observation of the asymptomatic patient, especially for those older than 65 years, may be the safest course. Operative repair, which can be performed using either an abdominal or thoracic approach, consists in reduction of the hernia, resection of the sac, and closure of the hiatal defect. In type III hiatal hernias, the esophagus frequently is shortened, and thus a thoracic approach may be preferred.

Paraesophageal hiatal hernias are associated with a 60% incidence of GER. Furthermore, the operative dissection may lead to postoperative GER in previously asymptomatic patients. Therefore, an antireflux procedure should be performed at the time of hiatal hernia repair. A recent prospective, randomized trial showed that the addition of a biologic mesh to reinforce the crural repair resulted in a decreased recurrence at 6 months