Diaphragmatic hernia repair is a surgical procedure used to correct diaphragmatic hernias, primarily addressing abnormal displacement of the stomach or abdominal organs into the thoracic cavity. The main goal is to reposition displaced organs to their normal anatomical location and repair the diaphragmatic defect to alleviate symptoms such as gastroesophageal reflux, dyspnea, and chest pain. This surgery is often combined with fundoplication to enhance lower esophageal sphincter function and improve reflux issues.
Depending on the severity of the condition and patient circumstances, the surgery can be classified into two main types: laparoscopic minimally invasive surgery and open laparotomy. Laparoscopic surgery involves inserting a camera and instruments through several small incisions, suturing the diaphragmatic defect with specialized sutures, and repositioning the stomach. Open surgery is suitable for complex or recurrent cases and requires a larger incision in the upper abdomen for direct tissue repair.
Mechanistically, the surgery primarily achieves its effects through the following steps: 1) pushing the displaced stomach or abdominal organs back into the abdominal cavity, 2) repairing the diaphragmatic defect to prevent recurrence, and 3) if severe reflux is present, performing Nissen fundoplication to create an anti-reflux valve structure.
The surgery is usually performed under general anesthesia, with a hospital stay of approximately 3-5 days. Laparoscopic surgery requires 3-5 small incisions of 0.5-1.5 cm, while open surgery involves a 10-15 cm incision in the upper abdomen. Postoperative fasting lasts 24-48 hours, with gradual reintroduction of diet according to medical instructions.
Potential short-term risks include: infection, bleeding, anesthesia-related complications. Long-term risks may include esophageal stricture (about 5-10%), difficulty swallowing, or delayed gastric emptying. Post-laparoscopic surgery, rare complications related to sutures, such as suture rejection or diaphragmatic re-rupture, may occur.
Patients should discontinue anticoagulants (such as aspirin) at least one week before surgery and control underlying conditions like diabetes. Contraindications include severe cardiopulmonary insufficiency, inability to tolerate anesthesia, or high-risk elderly patients with multiple chronic diseases.
Postoperative care includes dietary adjustments, such as avoiding high-fat foods and fasting for 3 hours before sleep. Antibiotics may be used temporarily to prevent infection but should be used cautiously to avoid interactions with anticoagulants. During rehabilitation, patients should avoid lifting heavy objects for at least six weeks.
Long-term follow-up shows that 85% of patients experience significant symptom improvement within five years after surgery, with a 60% reduction in gastroesophageal reflux-related hospitalizations. Randomized controlled trials confirm that laparoscopic surgery has a lower recurrence rate compared to open surgery, and patient quality of life scores improve by up to 40%.
Non-surgical treatments include: proton pump inhibitors (such as omeprazole) to control stomach acid, diet management for gastroesophageal reflux disease, or use of H2 receptor antagonists. Severe cases may consider endoscopic anti-reflux procedures (such as Stretta therapy), though long-term outcomes may not be as favorable as surgical intervention.
What preparations are needed before surgery?
Patients should undergo gastrointestinal cleansing before surgery and discontinue anticoagulant medications to reduce bleeding risk. The doctor will evaluate cardiopulmonary function and perform imaging tests based on the patient's age, medical history, and hernia severity to ensure surgical safety. Patients should fast for at least 8 hours on the day of surgery and bring pain relievers and care supplies for postoperative use.
How long does it take to recover normal activities after surgery?
Traditional open surgery typically requires 5-7 days of hospitalization, with a 4-6 week recovery period for daily activities; laparoscopic surgery shortens this to 3-5 days of hospitalization and 2-3 weeks of recovery. During the initial postoperative period, patients should avoid lifting heavy objects, bending over, or vigorous exercise, and gradually increase activity as advised by the doctor to reduce complications.
What dietary principles should be followed after surgery?
In the first week post-surgery, a low-fat, high-protein semi-liquid diet such as rice porridge or steamed fish is recommended, avoiding spicy foods and carbonated drinks. Meals should be divided into 5-6 small portions, with patients remaining upright for 30 minutes after eating, and elevating the head of the bed by 15 cm during sleep to promote wound healing and reduce acid reflux.
What are the criteria for choosing between laparoscopic and traditional open surgery?
Laparoscopic surgery is suitable for small sliding type gastroesophageal reflux disease, with small incisions and quick recovery. However, if the patient has had previous upper abdominal surgery or severe tissue adhesions, open surgery may be necessary. The doctor will assess the size of the hernia, the degree of anatomical abnormality, and the overall health status to determine the most appropriate treatment method.
What is the likelihood of complete disappearance of reflux symptoms after surgery?
Statistics show that approximately 85-90% of patients experience significant symptom improvement after surgery, but 5-10% may continue to have mild symptoms due to abnormal acid secretion or incomplete anatomical correction. Postoperative follow-up may include acid suppression medications or dietary adjustments to enhance long-term control.
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