Hiatal hernia and reflux surgery in Vienna

Heartburn and acid reflux are often caused by a hiatal hernia. When lifestyle changes and medication are not enough, a minimally invasive anti-reflux operation offers a permanent solution for most patients – laparoscopically or with the da Vinci robot.

What are reflux and a hiatal hernia?

In reflux disease, stomach contents flow back into the oesophagus. Normally a sphincter muscle at the junction of oesophagus and stomach prevents this. A hiatal hernia – where part of the stomach slides through the diaphragm into the chest – is often a contributing cause. More than 7% of Austrians suffer from reflux symptoms.

Symptoms

• Heartburn – a burning pain or pressure behind the breastbone
• Acid regurgitation
• Hoarseness in the morning
• Chronic cough or recurrent bronchitis

Over time, reflux can damage the lining of the oesophagus and – rarely – increase the risk of oesophageal cancer. Regular gastroscopy is therefore important.

Treatment options

The first step is usually a change in diet and lifestyle, which brings significant relief for many patients. Acid-reducing medication lowers stomach acid but cannot stop reflux itself, and long-term use can have considerable side effects. When these measures are not enough, surgery offers a permanent cure for most patients.

Examinations before surgery

• Gastroscopy – essential for every reflux patient
• Video-fluoroscopy to visualise swallowing
• Oesophageal manometry to measure the function of the oesophageal muscles (about 20 minutes)
• 24-hour pH monitoring to record acid exposure of the oesophagus

Reflux surgery: hiatoplasty and Toupet fundoplication

The operation is performed laparoscopically (keyhole surgery) under general anaesthesia and takes one to two hours. It can also be performed with the da Vinci robot – I carried out the first such procedures in an Austrian private hospital.

• Hiatoplasty: the widened opening in the diaphragm is narrowed to its normal size and the stomach is returned to the abdomen
• Fundoplication: the upper part of the stomach is wrapped around the lower oesophagus to create a new valve
• I use the Toupet technique (270° wrap), which causes fewer early side effects than the Nissen technique (360° wrap)

90–95% of patients achieve long-term freedom from reflux. About 20% may experience reflux symptoms again after 15–20 years.

After your operation

• Most patients go home the day after surgery
• Moderate pain relief is needed for a few days only; early mobilisation is encouraged
• Liquid and soft food for the first two weeks, while post-operative swelling makes the wrap temporarily tighter – then a normal diet
• No heavy lifting or straining for two months
• Temporary swallowing difficulties, bloating or difficulty vomiting can occur early on, but are less common with the Toupet technique

Priv. Doz. Dr. Emanuel Sporn – specialist in general, visceral and vascular surgery, international specialist in hernia surgery, Vienna.