Paraesophageal Hernia

[Tkimble01]

In November 0f 2001 I had a Nissan Fundiplication to repair a Hiatal Hernia.  That repair is still there and it seems as though my surgean did a nice job repairing it.  

In the past few years I have been having intermitent chest pains on the right side of my chest and lately (past month)it seems as though my stomach is constantly upset.  A few months ago the chest pain got bad to the point that I went to the Emergency Room.  After multitudes of testing including upper GI, xrays ultrasound, Hidascan and blood work it was determined that I did in fact have a Paraesophageal Hernia.  My surgean wants to repair it and suggested as soon as possible.  He stated that he is going to pull the stomach back down tack it to the inner abdomen wall and repair the weak tissues that the stomach went through.  He did state that he will attempt to do it laproscopically but there is a chance he may have to perform open surgery.  

My questions are as follows:
1. If I wait to have surgery are there symptoms that will occur
   before the hernia gets serious, or is that what I may be
   having now and further symtoms may be the potentialyl lethal
   ones?  I want to wait until October but my surgean
   recommended that I should do it sooner better than later.

2. Someone suggested I get a second opinion but isn't this like
   a broken bone (mechanical in nature).  I saw the pictures and
   it was there and I am comfortable with my surgean.  Is there
   another repair method I should be asking for a second
   opinion on? This seems like it would stretch the surgery out
   another two to three months.

3. After this repair via open or laparoscopic can I return to my
   active lifestyle (weight lifting, biking, etc.)?

Thank You
Tom    

[Kevin Pho, MD]

To answer your questions:
1) The symptoms of a paraesophageal hernia would depend on its type and severity.  Volvulus would be the complication that is pretty serious if not treated.  But as one of the commenters mentioned below, this is an atypical occurance.  In any case, conservative therapy does not work for paraesophageal hernia - I agree with the assessment that sooner is better than later.

2) If you are comfortable with your surgeon, I would consider proceeding with the surgery.

3) To my knowledge, there should be no restriction in lifestyle barring any serious complication from the surgery.

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.

Kevin, M.D.
http://www.straightfromthedoc.com

[surgeon]

The danger of a paraesophageal hernia is that the portion of the stomach that's herniating gets trapped and its blood supply cut off. That's a very dangerous situation. On the other hand, it's fairly rare for it to happen. There's no predicting if it will happen, nor any warning symptoms. It either happens or it doesn't. The odds would say that waiting is unlikely to be a problem; on the other hand, it could happen tomorrow. Or never. Whether it's fixed open or laparascopically, in the long run there should be no restriction on any activity you choose to do.

[Tkimble01]

Thank you for the response.  I think elective surgeyr is best.

[Tkimble01]

Thanks Again
August 19th is a go.  I really appreciate it.  The hardest things these days is separating from work for that time period although the alternative would be much worse.
Tom

[lpc]

SO HOW DID IT GO?  I AM ASSUMING THAT YOU HAD THE SURGERY.  DID IT WORK, AND DID YOU HAVE ANY SERIOUS SIDE-EFFECTS OR COMPLICATIONS?  THANKS - LPC

[Cricket221]

A related discussion, para-esohphageal hernia was started.