Digestive Disorders / Gastroenterology Expert Forum
RECURRENT PARAESOPHAGEAL HERNIA
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RECURRENT PARAESOPHAGEAL HERNIA


  I AM A 44 YEAR OLD FEMALE IN OTHERWISE GOOD HEALTH.  ABOUT 28 MONTHS AGO I HAD OPEN SURGERY TO REPAIR A MASSIVE HIATAL HERNIA, LATER TERMED PARAESOPHAGEAL HERNIA, WHICH HAD CAUSED ME A LOT OF PAIN, CARDIAC COMPRESSION, SOME VOMITING , SEVERE REFLUX, AND APPARENT INTERNAL BLEEDING, AS I STAYED ANEMIC (IRON DEFICIENCY).  I AM TOLD THAT MY ENTIRE STOMACH AND PART OF THE UPPER INTESTINE WAS IN MY CHEST. RESULTS WERE GOOD, EXCEPT FOR A VERY STRANGE RUMBLING OF MY GUT WHEN I TURNED WHILE LYING DOWN.  ABOUT 3 MONTHS AFTER THE SURGERY, THE PAIN RETURNED, BUT NOTHING WAS OBVIOUS WHEN MY DOCTOR EXAMINED ME.  15 MONTHS AFTER SURGERY, THE PAIN HAD BECOME SO SEVERE THAT FURTHER TESTS WERE RUN WHICH DETERMINED THAT THE HERNIA HAD RETURNED. 10 MONTHS AGO, THE SECOND SURGERY WAS PERFORMED BY THE SAME SURGEON. AFTER THE OPERATION, HE TOLD ME THAT HE HAD MADE A  MISCALCULATION THE FIRST TIME (ACTUALLY HE SAID HE HAD MESSED UP, HONEST) AND HAD LEFT TOO MUCH SLACK WHEN HE HAD ATTACHED MY STOMACH WHICH HAD ALLOWED PART OF MY STOMACH TO MIGRATE BACK INTO MY CHEST. HE SAID THAT NOTHING HAD COME LOOSE. I HAD TOTAL RELIEF FROM THE PAIN, WITH NO REFLUX OR EVEN HEARTBURN.
  ABOUT 3 MONTHS AGO, I HAD A SHARP, SEVERE PAIN RIGHT OVER THE AREA WHERE THE GASTRIC TUBE HAD BEEN INSERTED. SINCE THEN, THE WIERD RUMBLING, HEARTBURN AND REFLUX HAVE RETURNED, ALONG WITH INCREASING ALMOST CONSTANT TUGGING, BURNING DISCOMFORT IN MANY PLACES IN MY ABDOMIN (abdomen).  I FEEL SURE THAT AT LEAST ONE ATTACHMENT POINT HAS COME LOOSE AND I HAVE AN APPOINTMENT TO SEE THE SAME SURGEON IN LESS THAN A WEEK.
  I WOULD LIKE TO MAKE IT CLEAR THAT I AM NOT WANTING TO BLAME SOMEONE FOR MY PROBLEMS. I UNDERSTAND THAT MY CONDITION IS MUCH MORE COMPLICATED THE A USUAL HIATAL HERNIA.  IF SOMEONE HAD NOT OPERATED ON ME THE FIRST TIME, I WOULD HAVE DIED.
  MY QUESTION IS, HOW DO I MAKE SURE THAT MY SURGEON IS TRULY QUALIFIED TO DO THIS REPAIR? MY INTERNIST IS STILL COMFORTABLE WITH HIM, AND I FEEL THAT HE IS NOT IMPAIRED, BUT DURING THE SECOND SURGERY, THERE WAS SOME DAMAGE TO THE VAGUS (SP?) NERVE TO MY HEART WHICH CAUSED AN IRREGULAR HEARTBEAT WHICH KEPT ME IN INTENSIVE CARE FOR A LITTLE WHILE. THE SURGEON TOLD MY HUSBAND IT WAS REALLY CLOSE FOR A FEW MINUTES. AND NOW, IF THIS REPAIR HAS TRULY COME LOOSE, I FEEL  THAT I MUST TRY TO FIND THE MOST QUALIFIED PERSON THAT I CAN TO DO THIS REPAIR THIS TIME, BUT I DON'T KNOW HOW TO DO THIS. THINGS ARE GETTING WORSE VERY QUICKLY, SO ANY ADVICE YOU CAN GIVE ME WOULD BE GREATLY APPRECIATED.
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Dear Carolyn F.,
Paraesophageal hernias are clinically different from the more common sliding esophageal hernias.  Pains, vomiting, obstruction are among the symptoms of paraesophageal hernias as you experienced. Moreover, you are correct this condition is more complicated than the more usual hernias.  I am certain that you will have a barium study to confirm whether the hernia has in fact recurred or whther there is another cause for your symptoms.
To assess the qualifications of your surgeon, you should ask the appropriate questions about experience:
How many of this operation have you ever done?  How many during the last year?  What complications have you had?  Have you done cases in which the first surgery has failed?  Are there other alternatives to repeating the same operation?
If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital and perform the necessary investigations after we have had the chance to meet you and to review your history in greater detail. Depending on our assessment of your problem, we would then refer you to the appropriate surgeon.  You can arrange an appointment with Dr. Fogel, one of our experts in the diagnosis and treatment of esophageal disorders by calling the Henry Ford Physician Referral Line at (800)653-6568.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
HFHSM.D.-rf
*keywords: esophageal hernia
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