Hiatal Hernia Surgery – The Nissen Fundoplication
Once anesthesia is given, surgery begins with an incision on either side of the hernia. A laparoscope is inserted in to one incision, and the other incision is used for additional surgical instruments. The surgeon then locates the stomach and the defect in the diaphragm. If necessary, the stomach is pulled down through the diaphragm, out of the chest cavity and into the abdominal cavity.
The top part of the stomach is then “wrapped” around the end of the esophagus, and stitched or stapled in place. If the defect in the diaphragm is very large, it may be stitched closed or a mesh graft may be put in place, but this is not necessary in most cases.
The small laparoscopic incisions can be closed in one of several ways: with sutures that are removed at a follow-up visit with the surgeon, with a special form of glue that is used to hold the incision closed without sutures or with small sticky bandages called "steri-strips."