Questions in the Gastroenterology and Liver Diseases Forum have been answered by Dr. Kevin Pho who is board certified in Internal Medicine and by doctors from Henry Ford Health System.

Question Title: Nissen Fundoplication: Laproscopic vs. Thoracotomy?

Forum: The Gastroenterology and Liver Diseases Forum
Topic: Reflux Esophagitis


Having undergone the tests (monomatry, 24 hour pH, and upper GI) I am now faced with having surgery to correct a 7 cm hiatal hernia. Despite my pestering, my specialist conistently maintains that a 7 cm hiatal hernia cannot be repaired laproscopically (although he is a specialist in this procedure). He says the only way to really get good results for anything larger than 5 cm is through a large incision (thoracotomy).

Is there anyone in the United States who can perform this procedure laproscopically and give me good odds that it will be successful? I only want to have this done once, so I want it done right, but I don't want to undergo the thoracotomy if there is any reasonable option. I would greatly appreciate a prompt response; my surgery is scheduled for 9/22.

Thanks in advance.
PJH

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Dear PJH,
Review articles summarizing the role of laparoscopic and open surgical repairs indicate that a laparoscopic procedure is not for everyone. Obese patients, those with fixed hernieas. and those with HERNIAS GREATER THAN 5 cm in size should have an open procedure. Having written this, I also recognize that every case is unique and that these exclusion criteria are not absolute. I suggest thatr you ask your surgeon if he kbnows of any colleagues that would do an open procedure with a large hernia.

This information is presented for educational purposes only. Always consult your personal physician for specific medical questions.

HFHSM.D.-rf
*keywords: esophgeal reflux, hiatal hernia, surgery
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