By Sameria Zavala, WAMC PAODecember 7, 2017
Fort Bragg is the largest U.S. Army installation by population. This makes Womack Army Medical Center the premier location for retirees, active-duty service members and their Families to receive care.
A common condition that is treated at WAMC is acid reflux. Our doctors perform a procedure known as a hiatal hernia repair to solve, in some cases, life-changing discomfort.
A hiatal hernia is when part of a person's stomach is pulled up into the chest cavity. This eventually leads to severe acid reflux. According to Dr. (Lt. Col.) Viet Nguyn, Division of Medicine chief and gastroenterologist at WAMC, the goal of the surgical team is to bring the stomach back down into the abdomen and keep it there, preventing any further severe acid reflux and improving that person's quality of life.
Dr. (Maj.) Katherine Hetz, a WAMC robotics surgeon, stresses that the benefits of this surgery extend beyond just lessening the symptoms of acid reflux -- it can also reduce the chances of developing cancer.
"A hiatal hernia surgery can cure a patient's reflux and prevent injury to the esophagus that, if left untreated, can result in cancer to the esophagus," said Hetz. "It can also allow patients to no longer require medication for this."
The process to repair a patient's hiatal hernia involves freeing up the esophagus and any attachments it may have in the chest cavity, ensuring the muscle between the esophagus and the stomach remains in the abdomen. The surgeons then tighten the diaphragm to prevent it from moving up to the chest and use the stomach to tighten the muscle between the esophagus and the stomach.
Hetz explained that there are benefits for both the patient and the surgeon when opting for robotic surgery versus open surgery.
"Robotic surgery is different from open surgery in that we use smaller incisions and a camera and long instruments to perform the surgery rather than making a large incision," Hetz said. "It is frequently easier to see up into the chest and other small spaces with a camera rather than with open surgery."
Due to the small incisions, the expectation is that the patient has a faster recovery time and lower chances of any complications.
"Patients have less postoperative pain and faster recovery with robotic surgery," said Hetz. "Robotic surgery offers the advantage of a 3-D camera as well as being able to use instruments with articulation and the ability to reach into tight spaces and perform maneuvers has improved with these instruments."
Hiatal hernia surgery is generally very successful. The patients are required to follow a strict postoperative diet to allow the esophagus and stomach swelling that occurs from surgery to heal before they resume regular food.
According to Hetz, if this is followed and the patients maintain their weight to a BMI of less than 30, the chances of the hernia returning are low. Patients are asked to follow the diet and avoid any heavy lifting for four to six weeks after surgery.
For more information, visit the Journal of Robotic Surgery website at www.ncbi.nlm.nih.gov/pmc/articles/PMC4766202.
Editor's Note: This is a series article (part two of three) that will focus on the aspects of having a transoral incisionless fundoplication (TIP), a hiatal hernia repair via robotic surgery and the patient perspective on experiencing severe acid reflux.