Oesophageal Patients Association

Hiatus hernia operation

I am on a waiting list for keyhole surgery for a complex h.hernia operation. As they haven't found cancer I will have to wait, which is fair enough. My query is if anyone has had a similar operation, is there any advice to offer? The surgeon said it could improve the Barretts o. It seemed obvious at the time to go for it, but the longer I wait, the doubts creep in!

2 Replies

One of the causes of reflux is the failure of the lower oesophageal sphincter, the valve between the oesophagus and the stomach, to operate properly to stop the acid / reflux rising. The acid will have a long term corrosive effect on the oesophagus, and this brings in a risk of Barrett's Oesophagus and potential oesophageal adenocarcinoma.

A hiatus hernia involves part of the your stomach rising up above the sphincter, located with your diaphragm, so it will tend to give you reflux problems, often quite severe. So in order to combat that you would normally have to have long term Omeprazole or some other equivalent medication to reduce the pain and discomfort.

Having Barrett's Oesophagus is not necessarily in itself a big problem. the risk of cancer developing is less than 1% a year (but there is a cumulative effect year after year). So a person aged 30 with newly developed Barrett's may have a 12-25% chance of developing Barrett's by the time they are aged 80 years. If dysplasia develops within the Barrett's the chances of cancer develop very markedly. If it is low grade dysplasia there is a 5% chance of cancer in the next -8 years. If it is high grade dysplasia the equivalent risk is 50%. Although dysplsia can be treated with radio frequency ablation, having the untreated hiatus hernia might cause complications. And in any event there is a need for surveillance endoscopies every 3-5 years, or more frequently with Barrett's. And if cancer does develop and it is not caught in the very early stage, you may have to have an oesophagectomy operation to remove your oesophagus. This is major surgery, and if you can avoid the risk of having it in the future you should do so.

So I think your surgeon gave you very good advice and I would follow up their advice and have the hernia repair done. It is a good investment against future problems rather than something that always has to be done urgently, but I can quite understand your feeling of indecision as time has gone on. Surgery always takes place after an assessment of your condition and general fitness, and without being pessimistic, if you do choose to put this off, it might then present a complication for future treatment for something else that might crop up in the future. I think it will probably mean two or three nights in hospital, but your surgeon will clarify that part of things.

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Thank you for your reply. It helps to get an independent view.


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