Laparoscopic Esophageal Hernia Repair

A Laparoscopic Esophageal Hernia Repair is a surgical procedure used to fix a hernia in the upper stomach area where part of the stomach pushes up into the chest through an opening in the diaphragm. This can cause symptoms such as heartburn, chest pain, and difficulty swallowing. During the procedure, small incisions are made in the abdomen and a laparoscope is used to provide a clear view of the hernia. The hernia sac is then carefully dissected and removed, and the hernia is repaired by wrapping the upper portion of the stomach around the lower esophagus and suturing it in place to prevent acid reflux. The procedure is minimally invasive and is typically done under general anesthesia.

Equipment

Camera, light cord, bovie, trocers, and insufflation tubing.

Drapes

Legging drapes and a laparotomy drape will be used

Position

Lithotomy position with their legs in yellow fins. This is so the doctor can stand in between the patients legs at the foot of the bed. Their screen in usually right in front of them.

Anesthesia

The anesthesia team inserts an esophageal bougie to provide a clear view of the hernia. This helps the surgeon to see the exact location of the hernia during the procedure.

Step 1: Preoperative Preparation

Before the surgery, the surgical technologist should ensure that all necessary instruments are available and properly sterilized. The surgeon may use a Verres needle before they go in with their first trocar. It is very common for a Harmonic scalpel to be used, as well as an endostitch, and clip applier. A penrose drain should also be made available.

Step 2: Trocar Insertion

The surgeon makes small incisions in the abdomen and inserts trocars (hollow tubes) into the abdominal cavity. These trocars serve as ports for the surgical instruments.

Step 3: Laparoscope Insertion

A laparoscope, a small camera, is inserted through one of the trocars to provide a clear view of the hernia.

Step 4: Dissection of Hernia Sac

The surgeon carefully dissects and removes the hernia sac from around the esophagus, and returns any displaced stomach or other organs back to their proper position. During this step, the surgeon may use a Harmonic scalpel and an endostitch to dissect and suture the hernia sac.

Step 5: Repair of Hiatal Hernia

The hiatal hernia is repaired by creating a fundoplication. This involves wrapping the upper portion of the stomach (the fundus) around the lower esophagus, and suturing it in place to create a tighter valve and prevent acid reflux. The surgeon may use a clip applier to secure the sutures.

Step 6: Closure

After the repair is complete, the trocars are removed, and the small incisions are closed with sutures or surgical glue. A penrose drain may be placed to prevent the accumulation of fluid in the surgical area.

The Surgery Sparknotes

1. Trocar Insertion: Small incisions are made and trocars are inserted.
2. Laparoscope Insertion: Laparoscope is inserted through one of the trocars.
3. Dissection of Hernia Sac: Hernia sac is dissected and removed.
4. Repair of Hiatal Hernia: Fundoplication is created by wrapping stomach and suturing it in place.
5. Closure: Trocars are removed and incisions are closed with sutures or surgical glue.