How to deal with post-GERD surgery problem with hiatal hernia

[Elith]

I received GERD surgery in 2000 for hiatal hernia and reflux. I got bloated, gassy, pains in left shoulder post-op. Was told this would go away. It never did. I continue to feel full when eating & try to eat small amts. Now I get up with pain in lower left mid area of ribs...tender to touch. The doctor did post-op endoscopy and x-rays..he said my hernia (which was large) is hanging into my stomach, creating a lump and I think pressure. He apologized for the surgeon's failure to repair the hernia. The fundoplication was otherwise okay, but I do have some reflux since the ENT doctor told me that my larnyx continues to be inflamed. How can I have the hernia repaired. I don't have the slim figure since my stomach bulges out, now always have pain where I never did before. I cannot date as I pass gas all the time, just with a shift in my position. My internist says I have to get real bad before any doctor corrects this. Where can I go and what can I do.  The surgery was done out of UCSF med center. My insurance says, they will pay for another surgery.

[Kevin Pho, MD]

Hello - thanks for asking your question.

I agree with the comments below - you need to followup with your original surgeon as he or she would have the best vantage of what went wrong.  

If you comment that your stomach bulges out, it is possible that there is an abdominal wall hernia.  Acquired abdominal wall hernias primarily are those that develop from a previous surgical incision. They are the result of a variety of factors, including technical causes (eg, poor technique, inadequate suture material, insufficient tissue included in the suture, excessive tension), patient-based causes (eg, obesity, smoking, diabetes), and idiopathic causes (eg, wound infection, coughing).

Most abdominal wall hernias stemming from prior incisions should be surgically evaluated to prevent complications like incarceration and strangulation.  Depending on the surgeon, prosthetic material such as a mesh may or may not be used.  As I am not a surgeon, my insight is limited.

Regarding passing gas - again, this needs to be addressed with your original surgeon who did the procedure.  For temporary relief, you may want to try some of the over-the-counter medications such as Gas-X and Beano.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[surgeon]

I'd suggest starting with seeing the surgeon at UCSF one more time, at least to get an understanding of what was and was not done, and what they think is going on now. From what you wrote, it sounds like there's confusion about what kind of hernia remains. A hiatal hernia doesn't usually cause symptoms all by itself: it's that it can allow reflux. If anything, it sounds like the wrap to correct reflux is too tight, and could be dilated. It doesn't make anatomic sense to me that a hiatal hernia would be "hanging" into your stomach, or that it would created a lump -- especially if you mean a lump that's visible on your belly. That would be either an incisional hernia, or a form of muscle separation called diastasis, neither of which has directly to do with GERD or swallowing issues. So I think you need a surgeon's input to clarify your understanding. When I trained at UCSF in the 70's it was one of the very best surgical programs anywhere...I think you could still expect satisfaction from there.