OA Dr. Alexis Freitas, F.E.B.S.
Surgeon
European surgeon for coloproctology Attending Physician in the Wiener Privatklinik
Senior Physician at Göttlicher Heiland Hospital
Profilfoto Dr. Alexis Freitas

Diaphragm Hernia, Reflux Disease

How does one detect a diaphragmatic hiatal hernia and/or reflux of gastric juice? You may be suffering from burning pain behind the sternum, so-called heartburn, pain in the upper abdomen and (acid) regurgitation.

How to diagnose a diaphragmatic hernia with or without reflux? Optimal diagnostics include gentle gastroscopy with tissue sampling (biopsy), oesophageal diagnostics (manometry and impedance pH-metry) and radiological procedures (swallow x-ray with contrast agent).

Can all these examinations be done in the surgery? Yes, all these examinations will be carried out or coordinated by me.

Is an operation always necessary? No. Depending on the collected findings, I make the decision in coordination with you to try treatment by adjusting lifestyle and eating habits or to perform an operation by means of buttonhole technique (laparoscopy, fundoplication).

What is the risk if gastric acid enters the oesophagus (gastroesophageal reflux)? Gastroesophageal reflex disease (GERD) may result in changes in cells in the lower oesophagus in the case of repeated contact of the esophageal mucosa with gastric acid. This then gives rise to a so-called Barrett’s oesophagus (Barrett’s syndrome). Barrett’s oesophagus increases the risk of getting cancer of the oesophagus. Therefore, it must be closely monitored and further reflux of gastric acid into the oesophagus should be prevented, be it through dietary control or, if not otherwise possible, by way of an operation.

How is the operation done? There are several surgical techniques (the Nissen-Rosetti operation,operation according to Toupet, Plicator fundoplication, etc.) Depending on findings, I decide with you on the right method for you. This surgery is performed by means of 4, 3-5mm long incisions by laparoscopy (laparoscopic fundoplication).  

How long does the surgery last? I need 45-60 minutes to perform a laparoscopic fundoplication.

What is to be expected after the operation? Taking painkillers, you will have almost no postoperative pain. You are allowed to go home on the second day after the operation. You will have 4, maximum 5mm long scars. You must not lift anything heavier than 5kg for 4 weeks after surgery. After the operation, you should chew food well and divide it into several smaller meals. You should drink in small sips and not drink too much at once.

If the indication is correct, the results of the operation are very good.