A hiatal hernia occurs when a portion of your stomach pushes upward through your diaphragm. Your diaphragm normally has a very small opening (hiatus) that allows your food tube (esophagus) to pass through on its way to connect to your stomach. The stomach can push up through this opening and cause a hiatal hernia.
Hiatal hernias are very common and several factors contribute to the condition: increasing age, obesity and smoking.
For a large number of cases, symptoms are not present and you may not even know you have the condition. But larger hiatal hernias can cause food and acid to back up into your esophagus, leading to heartburn and chest pain. Many individuals with hiatal hernia may also have gastroesophageal reflux disease (GERD).
Nissen fundoplication is a surgical procedure used to treat larger, symptomatic hiatal hernia and reflux. During fundoplication surgery, the upper curve of the stomach (known as the fundus) is carefully wrapped around the junction of the esophagus and stomach and sewn into place. This creates a barrier that prevents the flow of acid into the esophagus. The hiatal opening is also reduced in size with sutures.
Nissen fundoplication can be done as either traditional "open" surgery or a laparoscopic procedure. The open procedure involves a larger incision in the abdomen, while the laparoscopic approach is a minimally invasive technique using significantly smaller incisions.
St. Elizabeth Robotic Surgery Center offers the latest approach to treating hiatal hernia - robotic assisted Nissen fundoplication surgery with the da Vinci® Si™ Surgical System.