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Type 3 hiatal hernia

Posted by skhollandmt @skhollandmt, Jul 1, 2023

Just looking for thoughts/advice. Had a large paraesphogeal hernia repair in 2012 that has since failed. Now have a recurrent sliding and non sliding (paraesphogeal) that is 6.5 cm. I have some symptoms but don't have the horrible heartburn I had before the first surgery.
So question................to do or not to do surgery??
Lots of risks with surgery (any surgery!) vs symptoms are annoying but not overwhelming.
Doc doesn't think any risk of incarceration of the hernia.....
So do I do it now.....wait to see if it worsens?
Who's had this done....and at Mayo......and what's your thoughts?
I don't want to do a surgery and end up worse off than if I just dealt with the symptoms.

Thanks,
Steph

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RefluxGoAway | @njp515 | Jul 2, 2023

Hi, Steph,
My situation is very similar to yours. I had a Nissan Fundoplication and hernia repair in January of 2020 (just before Covid), and everything went splendidly throughout the surgery as well as the immediate recovery. In 2022, I had a CT Urogram for blood in urine, and the report came back with a description of a giant hiatal hernia belying my history of a fairly recent hernia repair. I returned to my surgeon who sent me for a series of other tests, and he confirmed that the hernia repair not just failed, but that my original 6.5 cm paraesohageal hiatal hernia is now 12 cm. Oddly, I have minimal to zero acid reflux and am completely off of PPIs, although an occasional OTC tablet is required with a large meal. My weight has returned to its original pre-surgery range, but I am not obese. The only hint that something was wrong is that I get a pinching in my upper abdomen when I flex my abs and I sometimes have uncontrollable belching and flatulence.
I discussed a hernia repair re-do, thinking it would be best to get it done before I advance in age and have to deal with other issues (hip replacements, arthritis, etc etc), but the surgeon was/is adamantly opposed to surgical re-do. He said that since I am not experiencing consistent discomfort, and motility is normal, no suspicious esophageal/gastric/duodenal mass identified, lungs are clear, and all other organs appear unremarkable, then open surgery re-do (which is the likely method) would be a bad idea as would attempting another laparoscopy surgery. I then went to a totally new hernia specialist for a second opinion, and he also recommended I follow the instructions of my original surgeon.
Subsequently in 2023, I went to my gastroenterologist to discuss the situation, and he ordered an upper GI/endoscopy to check for Barrett's and anything else. The results were that -- remarkably-- the wrap is intact and thus the reason why I have no unusual reflux, but the hernia repair failed. This is not something that the surgeon, after all his tests, told me, and in fact all our conversations were regarding the "failed Nissen".
The gastroenterologist told me in no uncertain terms that he, in my shoes, would not have a surgery re-do at this time. He admitted that the hernia could possibly get bigger, more obstructive, and more uncomfortable, but it could also remain as is. But, it will never get smaller, either.
I'm okay with the status quo, but I do live with the unease of knowing that potential complications may occur in the future. I'm trying to eat small meals, lose weight, reduce my urges to move furniture and lift heavy objects. I'm trying to stay healthy in other ways, just in case a bigger more urgent surgery is unavoidable.
Hope this helps a little, Naomi

REPLY
1 reply
skhollandmt | @skhollandmt | Jul 2, 2023
In reply to @njp515 "Hi, Steph, My situation is very similar to yours. I had a Nissan Fundoplication and hernia..." + (show)
@njp515

Hi, Steph,
My situation is very similar to yours. I had a Nissan Fundoplication and hernia repair in January of 2020 (just before Covid), and everything went splendidly throughout the surgery as well as the immediate recovery. In 2022, I had a CT Urogram for blood in urine, and the report came back with a description of a giant hiatal hernia belying my history of a fairly recent hernia repair. I returned to my surgeon who sent me for a series of other tests, and he confirmed that the hernia repair not just failed, but that my original 6.5 cm paraesohageal hiatal hernia is now 12 cm. Oddly, I have minimal to zero acid reflux and am completely off of PPIs, although an occasional OTC tablet is required with a large meal. My weight has returned to its original pre-surgery range, but I am not obese. The only hint that something was wrong is that I get a pinching in my upper abdomen when I flex my abs and I sometimes have uncontrollable belching and flatulence.
I discussed a hernia repair re-do, thinking it would be best to get it done before I advance in age and have to deal with other issues (hip replacements, arthritis, etc etc), but the surgeon was/is adamantly opposed to surgical re-do. He said that since I am not experiencing consistent discomfort, and motility is normal, no suspicious esophageal/gastric/duodenal mass identified, lungs are clear, and all other organs appear unremarkable, then open surgery re-do (which is the likely method) would be a bad idea as would attempting another laparoscopy surgery. I then went to a totally new hernia specialist for a second opinion, and he also recommended I follow the instructions of my original surgeon.
Subsequently in 2023, I went to my gastroenterologist to discuss the situation, and he ordered an upper GI/endoscopy to check for Barrett's and anything else. The results were that -- remarkably-- the wrap is intact and thus the reason why I have no unusual reflux, but the hernia repair failed. This is not something that the surgeon, after all his tests, told me, and in fact all our conversations were regarding the "failed Nissen".
The gastroenterologist told me in no uncertain terms that he, in my shoes, would not have a surgery re-do at this time. He admitted that the hernia could possibly get bigger, more obstructive, and more uncomfortable, but it could also remain as is. But, it will never get smaller, either.
I'm okay with the status quo, but I do live with the unease of knowing that potential complications may occur in the future. I'm trying to eat small meals, lose weight, reduce my urges to move furniture and lift heavy objects. I'm trying to stay healthy in other ways, just in case a bigger more urgent surgery is unavoidable.
Hope this helps a little, Naomi

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Thank you SO much for taking the time to respond. This was exactly what I was hoping for, someone with similiar situations and their experience.
The only reason I even consider having the redo is because as a nurse, I have seen cases of incarceration and what people go through. HOWEVER, I've also seen post-repair complications with patients as well.
It's a lot to consider, there is no one in my area who could take care of me if this became a surgical emergency BUT, if I have surgery at Mayo there's no one here if I have post surgical complications. Ugh
I occasionally get food stuck, and have an ongoing nagging upper left abd pain. Other than that and the belching episodes I think I do pretty good.
Thanks again for the reply! Lots to think about an consider!
Steph

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