In era of gold standard laparoscopic surgery, a study profile of open Nissen’s fundoplication for drug refractory endoscopically diagnosed and manometrically confirmed hiatus hernia in a tertiary care hospital

Abstract

Hiatus hernia is a condition in which part of the stomach protrudes into the chest cavity through the esophageal hiatus, a hole in the diaphragm. The condition is often asymptomatic but can cause gastroesophageal reflux disease (GERD), dysphagia, chest pain, and other complications in some cases. The diagnosis of hiatus hernia is typically made using imaging tests such as endoscopy or radiography and confirmation done using esophageal motility studies. Management of hiatus hernia depends on the severity and symptoms of the condition. Mild cases may be managed with lifestyle modifications such as weight loss, dietary changes, and avoiding certain trigger foods. Medications such as proton pump inhibitors (PPIs) and histamine receptor antagonists may also be used to control GERD symptoms in maximum number of cases. Surgical intervention will be necessary for more severe cases or cases that do not respond to conservative management. The two main types of surgery for hiatus hernia are conventional/open Nissen fundoplication and laparoscopic fundoplication. These procedures aim to strengthen the lower esophageal sphincter and prevent stomach acid from flowing back into the esophagus. Overall, the management of hiatus hernia requires a multidisciplinary approach involving gastroenterologists, surgeons, and primary care providers. The optimal management will be an individualized approach addressing severity of symptoms and responses to drugs. This study aims to review the drug refractory cases of hiatus hernia in a select group of adult patients not eligible for standard laparoscopic approach diagnosed endoscopically and managed by open Nissen’s fundoplication.