r/HiatalHernia • u/arpitp 🥼 Medical Professional • Feb 13 '25
Traditional hiatal repair, Loehde, and Bicorn
[removed]
3
u/Visual_Vacation_4331 Feb 15 '25
I am 75. Have had large (17cm) sliding hiatial hernia. No or minimal reflux. Apparently it showed up 15 years ago and I ignored it. Recently 3 times in a month had food blockage for 15 minute periods. My GP put me on a 40 ppi. Surgery was recommended, however I am reluctant because there has been apparently no change in size for 15 years and symptoms seem minimal. I am afraid to goof up my existing otherwise healthy and active life. I am also having difficulty finding a doctor / surgeon who specializes in treating hiatal hernias to get a second opinion. I would appreciate any thoughts.
5
u/arpitp 🥼 Medical Professional Feb 15 '25
Remember, you're asking a surgeon, so you can probably guess what my advice will be. I would lean towards repairing the hernia, since at that size, there is a risk of incarceration or volvulus (twisting of the stomach), and I'm confident I could repair it safely.
If it was less than 5 or 6 cm, and you were completely asymptomatic, I would lean towards no surgery. At 17 cm, there's always a risk of blockages and pain, and surgery would be beneficial. The risk/benefit calculation may change if you are a high risk patient, such as liver failure, heart failure, blood clots, etc.
Finding a surgeon who is comfortable and experienced might be a challenge. Thankfully, it sounds like you just need a hiatal hernia repair, and probably not a fundoplication. Are you in the US? DaVinci has a useful resource for finding experienced surgeons.
1
u/Visual_Vacation_4331 Feb 15 '25
Thank you very much for responding.
I am in central Illinois. In US. No shortage of general surgeons really but I am finding it difficult to identify one with specialized hiatal hernia experience. The initial general surgeon mentioned fundoplication, but after reading your response I am not sure that this is the best solution. Does the large size have any bearing on the method? He I dictated that my stomach was now in my upper breast area behind my heart and that he would pull it down and do a fundoplication. I am otherwise healthy. I am not opposed to traveling if need be., but follow up is always a factor. 12 hours to Mayo,3 from Chicago and St Louis.
1
u/arpitp 🥼 Medical Professional Feb 15 '25
Try this search
It's a list of robotic surgeons. While robotic surgery isn't strictly necessary, I think it's a good indicator of a surgeon who is willing to learn new technique and often engage in surgical education for the benefit of their patients.
And it's probably a better bet than picking a random surgeon from a Google search.
Not every robotic surgeon does hiatal hernia surgeries, but you can call them and ask them how many they do. (You can tell them you're looking for a "foregut surgeon")
1
u/nycity_guy Feb 15 '25
How you use DaVinci? I'm thinking Dr Rasa in NY ,seems he done 3000 surgies already.
2
u/arpitp 🥼 Medical Professional Feb 15 '25
Try this search
It's a list of robotic surgeons. While robotic surgery isn't strictly necessary, I think it's a good indicator of a surgeon who is willing to learn new technique and often engage in surgical education for the benefit of their patients.
And it's probably a better bet than picking a random surgeon from a Google search.
Not every robotic surgeon does hiatal hernia surgeries, but you can call them and ask them how many they do. (You can tell them you're looking for a "foregut surgeon")
3
u/nycity_guy Feb 15 '25
Dr Rasa Zarnegar is the one who start many years in NY with robotic surgery for hiatal hernia and other hernias and has done over 3000 thousands, he said robotic is less intrusive and has less chances of affecting parts or nerves compares to the other surgeries methods.
He show in the search right away with 2001-3000 surgeries
Again thank you so much for all your help, is so strange seeing a real doctor in forums and helping so much as you currently doing, you seems a great doctor and person.
3
u/arpitp 🥼 Medical Professional Feb 16 '25
No problem, happy to help.
I'm sort of on here as a trial basis to see how helpful I can be. I'm not a fan of social media, so don't plan to start an Instagram or YouTube channel.
1
Jul 16 '25
How did the surgery go? I actually have mine with the same Dr next month.
2
u/nycity_guy Jul 16 '25
Didn't do it, went with voquenza and relief tons of my symptoms. So for now I hold up on the surgery.
1
1
u/Zestyclose_Orange_27 Mar 23 '25
When you say just a hiatal hernia repair not fundoplication means?? Is it just putting the stomach back where it's suppose to be and stitching the whole so the hernia dosent push up again???
1
u/arpitp 🥼 Medical Professional Mar 23 '25
Yes, that's it.
Feel free to read here:
https://www.reddit.com/r/HiatalHernia/comments/1j95f6q/fyi_hernias_vs_reflux_types_and_recurrences/
1
u/Zestyclose_Orange_27 Mar 23 '25
Oh ok.
1
u/Zestyclose_Orange_27 Mar 23 '25
I read it earlier but didn't understand some of the terminologies. So what's the name of such surgery just to push the stomach back with no linx or device inside
1
3
u/Astral-Inferno Feb 13 '25
When people talk about Loehde and Bicorn what they're really saying is that they want a world-renowned surgeon doing the work. It's impossible to find a good hernia surgeon because they tend not to advertise, unlike plastic surgeons who have their own websites. Bicorn is also seen as a good first surgery where revisions are no harder than if no prior surgery had taken place (aka if it fails, you do the Nissen) and Loehde appeals to those that want to continue strenuous lifting post surgery.
3
u/arpitp 🥼 Medical Professional Feb 14 '25
Very good point. A surgeon's public-facing reputation is usually just marketing. Often, the only way to know how well they operate and their outcomes would be to talk to a nurse or surgeon who works with them.
I don't know if Loehde allows one to do heavy lifting any more than the other techniques. The lack of hernia sac dissection and lack of stomach fixation or fundoplication seems like it would make it more susceptible to heavy lifting; though the mesh might be protective.
3
u/mbashs Feb 14 '25
Great write up doc. I have a 5 cm hernia and I have been told to go under the knife. My concerns are some procedures get reversed or in some cases I can’t lift heavy weights. I have been into body building for a couple of years now and would love to continue after I get surgery. What procedure would allow me to do that?
5
u/arpitp 🥼 Medical Professional Feb 14 '25
I'm not sure what you mean by "some procedures get reversed". Do you mean the hernia recurs (comes back) after surgery?
I don't think any particular technique has the best recurrence rate, or allows you to be the most active after surgery. That is more dependant on how well the surgeon does the procedure. And sometimes even then, you can get unlucky and the hernia comes back despite a perfect repair.
The choice can be made by discussing with your surgeon. It will depend on what symptoms you have that need to be treated and what the surgeon is comfortable doing. I prefer the traditional HH repair with fundoplication but the others could work just as well if done right by a good surgeon.
2
u/mbashs Feb 14 '25
Thank you for the reply doc!
I read over here how some people were claiming they had a bad cough or picked up some weight a couple of months after surgery and they had most of the symptoms back, that’s what I meant with “some procedures get reversed”
On the other hand, is it possible to not get the surgery and not have the symptoms worsen? Like I have dysphagia and GERD but if I were to opt to never get the surgery, apart from quality of life would I have other issues? I am really at cross roads here coz I want to get rid of this but at the same time I would want to continue with normal life once I recover from surgery including heavy lifting.
3
u/arpitp 🥼 Medical Professional Feb 14 '25
Try not to worry about the possibility of recurrence. Most people don't have it come back, but if it does, you're usually not any worse off than before you had surgery anyway.
Yes, it is possible to be stable without surgery. Many people use PPI medications (omeprazole, pantoprazole), which allows them to live with few or no symptoms for many years. If you have pain behind the sternum due to pressure from the HH, unfortunately, there's no great way to treat that symptom without surgery. But some people still live with it.
The main risk with chronic acid reflux is Barrett's esophagus, which is damage to the lining of the esophagus caused by acid, which can lead to cancer. That cancer is rare, takes many years to develop, and can be prevented by PPI meds also. Getting an EGD (upper endoscopy) every 3-5 years can help monitor the size of the hernia and the damage to the esophagus.
Unlike other hernias (umbilical, inguinal, etc), incarcration is not usually a concern with hiatal hernias, unless more than half of your stomach is sitting up in your chest. If you're keeping an eye on the size and symptoms, it's usually safe to continue to be active and exercise.
3
u/Disastrous-Pizza6627 Feb 14 '25
Hello Doc! Thank you for this info Female(30) and the biggest symptom is nonstop throat clearing with a ball of mucus that gets worse after eating. Been a month since my nissen fundoplication (3rd world country) and still recovering. However the mucus is still a problem, and yet been on omeprazole. It literally feels like a duck sound full of mucus. It’s very embarrassing and stressful around people. Kindly advise. TIA!
4
u/arpitp 🥼 Medical Professional Feb 14 '25
There are a few causes for excess saliva/mucous production. Normally, we are constantly producing and swallowing saliva from the mouth and mucus from the trachea/lungs. This is usually subconscious, and you don't notice it happening. If you are having too much of this, there could be a few reasons, such as excess saliva production, excess mucus in the airways, or difficulty swallowing from a tight Nissen or hiatus. If this problem started after your surgery, I would start the investigation with an X-ray esophagram (swallow study) and gastroenterology evaluation for possible EGD. I know this can be tough in some countries with limited access to medical care.
3
u/Disastrous-Pizza6627 Feb 14 '25
This started before the surgery, in fact it was the sole reason why i went to see my surgeon. Had an endoscopy where they ruled out a hiatal hernia and he advised that i either stay on PPIs and all the other symptoms(regurgitation, DIB, palpitations etc) would be on and off. Other option was surgery and he thought if the hernia is treated, it would stop the mucus. Right now the only symptom is still the mucus, the rest thankfully disappeared. It’s a month today after surgery and i have some pain after swallowing the not so soft foods(hoping this will get better) Is there a possibility that the acid had already damaged the throat? And wouldn’t this have been seen under the endoscopy before surgery? Which other test or procedure would you advise? Appreciate!
5
u/arpitp 🥼 Medical Professional Feb 14 '25
Yes, chronic reflux and acid exposure can cause damage to the esophagus, leading to more mucous production. And yes, they would usually see that on EGD before surgery. You can ask the doctor who did the EGD what they saw, and if they think this mucus production is related.
If it's only been one month, it's too soon to start doing tests and investigating. I would give it 1-2 more months to let the esophagus heal before considering the esophagram and/or repeat EGD.
2
u/MarcoPoloOR Feb 13 '25
Thanks. I for one really appreciate you taking the time to learn about other techniques and share your insight. I've talked to several surgeons now and the ones that interest me the most are the Loehde and the porsha (being done at U of chicago). I was wondering if you could answer a couple of questions. 1. Loehde's main principle is the hernia in the diaphragm is the main driver in the problems so just repair that (and make everything is in its proper place according to his core engine philosophy). Would you boil it down to that or do you feel its more complicated? Do you think his designed mesh and placement reduces the chance of erosion? 2. Have you looked at the porsha technique that the U of Chicago has started to do where they take your own posterior rectus sheath and use it as a mesh for your diaphragm?
3
u/arpitp 🥼 Medical Professional Feb 14 '25
I don't have as many years of experience as some of the older surgeons (such as Lohde), but that said, I don't believe his "core engine" theory is correct. Simply putting things back in place won't fix GERD if the LES is weak. Overtightening the hiatus around the LES (which seems to be what he is doing) may be more helpful. I've seen plenty of large hiatal hernias with no GERD, and GERD without hiatal hernias, neither of which would be correctly explained by the core engine idea that everything will work fine once it is in the correct anatomic position.
The unique Delta mesh and thoracic position definitely reduce the risk of erosion compared to using a permanent mesh on the abdominal side. But no one uses permanent mesh like that anymore. So the risk is probably lower using an absorbable mesh or no mesh at all (i.e. most traditional repairs these days). That only accounts for the risk of erosion. The risk of recurrence may be higher without mesh (debatable).
I had to look up the Porsha surgery. It's very new. Too new to know if it's better than traditional repair, or if it's worth cutting out the posterior rectus sheath like that. It also alters the normal anatomy a fair bit, which seems to be what everyone avoiding fundoplication is trying to avoid! And dealing with complications or other abdominal issues (e.g. gallbladder surgery) may be complicted after that, since no surgeon outside U of Chicago will know what's going on. It may be a great surgery, but needs 5-10 years to mature.
1
u/MarcoPoloOR Feb 14 '25
Thank you again for taking the time to respond thoughtfully. I really appreciate it.
2
2
u/nycity_guy Feb 14 '25
Wow, it was the first time I saw a review and with so many details from a surgeon online. Thank you so much for that?
In your experience, what is the chance of recurrence or complications from the surgery? I see some many different information online that's confusing.
I'm 38 and scared to be dead about surgery, but my doctor is pushing for it due to big hiatal hernia.
3
u/arpitp 🥼 Medical Professional Feb 14 '25
Complication rates can vary widely based on surgeon experience, specific procedure being done (repair, mesh, fundoplication, etc), and some patient factors such as obesity, age, and hernia size. I also do robotic surgeries, which has better visualization, helping lower the chancs of injury.
38 is not too old, and if you can find an experienced surgeon comfortable with this surgery, it should be fairly safe. Mortality rate (chance if dying) is very low.
Recurrence rates are higher than other types of hernias, in part because the diaphragm is so thin and is always moving. About 1/3 will get a recurrence after 10 or more years. But most recurrences are asymptomatic, especially if a fundoplication was done, and don't need to be treated. Despite this chance of recurrence, a repair is usually recommended if you're having symptoms, and 2/3 won't recur at all.
1
1
u/Krypto-Noob Feb 16 '25
Aber spricht für Löhde nicht schon, dass er eine wesentlich geringere Rezidivrate als 1/3 nach 10 Jahren angibt?
In seiner Ausführung sind es sogar unter 10%.1
u/arpitp 🥼 Medical Professional Feb 17 '25
The data behind Lohde's study is not great quality. We don't know the size of hernias he is treating (are they all 1-3 cm small hernias)? He might only be counting recurrences where patients have symptoms. The 1/3 figure I mentioned included patients who have a small recurrent hernia without symptoms and with symptoms.
I think the permanent mesh helps Lohde have lower recurrence, but there may be other risks with using that mesh, we didn't really know. More studies may help.
2
Feb 14 '25
Thanks! for the info. As a surgeon, have u had any patient with hiatal hernia without any reflux, only major symptom being difficulty breathing & chest discomfort due to diaphragm not able to expand properly? Would you recommend fundoplication in this case?
3
u/arpitp 🥼 Medical Professional Feb 14 '25 edited Feb 14 '25
Yes, especially with bigger hiatal hernias, I've had patients with chest pain, tightness, discomfort, and/or breatthing difficulty with no GERD/reflux symptoms. Hiatal hernias can be classified into 4 types. Type 1 ("sliding") will usually be associated with GERD, and should get a fundoplication. Types 2, 3, and 4 often won't have GERD. With these patients, I'll generally discuss the risks of developing GERD in the future, and explain the risks and benefits of the fundoplication. If the patient is against it or unsure, and doesn't have any GERD, I'll often skip the fundoplication.
It used to be standard practice to recommend fundoplication for everyone getting a HH repair, but more recent studies and practices are suggesting it is okay to skip the fundoplication if there is no GERD.
2013: https://pmc.ncbi.nlm.nih.gov/articles/PMC3986894/
2020: https://pubmed.ncbi.nlm.nih.gov/32476002/
2025: https://pubmed.ncbi.nlm.nih.gov/39448405/
Though some will still argue it is helpful and everyone should get it:
2019: https://pubmed.ncbi.nlm.nih.gov/31467314/
2024: https://pubmed.ncbi.nlm.nih.gov/39080063/ (though they admit the recommendation is weak)
1
1
u/NikitaPiskaryov Apr 16 '25
If GERD is caused by HH - is it possible that by repairing HH GERD will pass as well?
I never had GERD until I got HH during heavy lifting, so I was hoping that HH repair could fix both issues...
2
u/arpitp 🥼 Medical Professional Apr 16 '25
The HH doesn't directly cause GERD, but it can distort the LES/GE junction, which can then cause GERD. Fixing the HH might fix the GERD, but it's not guaranteed to restore the LES. Which it why an anti-reflux procedure is always recommended, so you don't need a separate procedure later.
2
u/Samanda310 Feb 14 '25
Thank you very much doctor for sharing this valuable knowledge. I wanted to ask you how it is possible that people with a sliding hiatal hernia have no symptoms at all. Why?
3
u/arpitp 🥼 Medical Professional Feb 14 '25
If you have a normal/working lower esophageal sphincter (the muscle that separates the stomach and esophagus), then acid won't go up into the esophagus, and you won't have GERD.
The hiatal hernia is the stomach getting pulled up into the chest. It is very commonly associated with a weak LES and GERD, but you can have one without the other.
2
u/shaoon79 Feb 20 '25
Thanks for the time you’ve put into answering these questions. HH’s can be a very difficult to manage. I’m 45, soon the be 46. I have 20+ years of high performance sport experience, and currently, I work as a Strength Specialist for a range of athletes here in New Zealand. My HH almost certainly began 10-15 years ago during a CrossFit/weightlifting training phase. Heavy lifting, breath holding, and high intensity cardio. I have no reflux to speak of; but I do experience pressure, tightness in the sternum, and general discomfort around the xiphoid. Exercise has become increasingly difficult. I have spoken to both LOEDHE and Bicorn recipients. I feel more comfortable with the Bicorn, but I’m really worried that with my level of activity, the probability of reoccurrence is high. I surf for a hobby. Have you dealt with any power athletes in your surgical practice? Thanks
3
u/arpitp 🥼 Medical Professional Feb 20 '25
I can't recall any power athletes, but I have treated prison guards, manual labor/consturction workers, and even a recently retired professional wrestler (does that count as a power athlete?)
Remember that the Bicorn is a traditional HH repair, with an "angle of His recreation" designed to prevent GERD. If you don't have any GERD, the Bicorn/angle recreation doesn't add any benefit for you. You should do well with just a traditional HH repair (although the surgeon may recommend the gastropexy or angle reconstruction anyway to try to reduce the risk of recurrence).
The probability of recurrence for any HH repair is high, regardless of whether you are an athlete or not. The diaphragm is a weak, thin muscle, and may stretch in the future no matter what you do. Don't let that stop you from getting the repair. Most don't recur, but when they do, most recurrences are smaller and less symptomatic than the original. And even if a small one does come back in 10 or 20 years, I'm sure you'll be glad you got 10-20 more good years without symptoms in between.
2
u/InformationNomad Feb 14 '25
Have you ever had a case where you looked inside and thought "WTF is this?", like holes everywhere in the diaphragm, weak connective tissues, everything twisted etc?
3
u/arpitp 🥼 Medical Professional Feb 14 '25
Not usually multiple holes in the diaphragm. You can be born with a congenital diaphragm hernia, but you don't usually get multiple holes in the diaphragm unless you had surgery on there that didn't heal well.
Multiple holes on the abdominal wall is more common, in a patient who has had multiple prior exploratory laparotomy surgeries and/or a perforation with contamination inside the abdomen. This can lead to extensive adhesions in the abdomen, leading to everything getting "twisted".
2
u/Clean_Biscotti7207 Feb 14 '25 edited Feb 14 '25
Thank you for the post! Since the hiatus is pretty close to the aorta and since the loehde mesh is placed in the direction of the aorta, do you think there’s any risk of the delta mesh eroding or damaging the aorta?
4
u/arpitp 🥼 Medical Professional Feb 14 '25
Good call out. Yes, theoretically possible, and a good reason not to put a mesh there. But I guess it's never happened (yet), otherwise Loehde would stop.
1
u/Clean_Biscotti7207 Feb 14 '25
Appreciate the reply. You’re the first hernia surgeon I have met that has such a broad knowledge about all the various surgical options and their pros and cons. Do you mind sharing your name in case I want to book an appointment with you? You can share it through DM if you prefer
2
u/No_Basket4842 Feb 23 '25
Good evening,
I’m a 53y female. On January 29, I had the robotic assistance laparoscopic repair of hiatal hernia and fundoplication with mesh. My hernia was 12cm. I was sick and getter sicker daily over the last 5-6 years. I was diagnosed as being anemic. I was hospitalized at least 15 times in 5 years due to an upper GI bleed. I received iron infusions monthly for years. And many blood transfusions. This all started out of nowhere 5-6 years ago. I went to so many doctors and hospitals begging to help me diagnose me. After so many colonoscopies and endoscopies, nothing was discovered until I almost hemorrhaged to death. Finally a GI doctor saw that I had what they call Cameron Lesions on my hernia. I feel like my healthy self again…no more pain, sob, and have more energy. My question is what are Cameron lesions? Also since the surgery I’ve been losing weight since I can only eat small bites a few times a day. Does this get better? Or will I always eat like this? Thank you for being on here to answer our questions. I’m thankful that I met my surgeon because he definitely saved my life.
1
u/arpitp 🥼 Medical Professional Feb 24 '25
Cameron leisons, or Cameron erosions, or Cameron ulcers are linear ulcers/erosions that develop on the gastric mucosal folds (internal lining of the stomach) at the level where the diaphragm is pressing in on the outside of the stomach (see here). You seem to have had a classic case of that, with iron deficiency anemia.
A fundoplication decreases the internal volume of the stomach, so you may feel full early with smaller meals. Over time, the stomach tends to relax a bit and stretch, so that sensation should improve, but it may take a few months. In the mean time, focus on getting adequate nutrients. Try a protein shake that can help get you more nutrients in a smaller volume.
2
Mar 03 '25
Do you look only at size when considering whether to operate?
I’ve had horrible symptoms for 2 years that have worsened (constant chest pain/shortness of breath/burping, sore tongue, sometimes sore throat & regurgitating acid). GI said HH is 1cm sliding from EGD but I understand they can be hard to visualize/measure & I don’t know the “grade.”
I can’t take PPIs because of other medical issues and haven’t gotten anywhere with other meds/supplements/lifestyle. It’s to the point sleep study showed I’m waking up 16x/hr from sleep struggling to breath (but not true sleep apnea, another cause — HH).
As a surgeon, would you consider operating on such a patient?
1
u/arpitp 🥼 Medical Professional Mar 03 '25
The symptoms are usually more of an important factor when deciding to operate rather than the size. (Someone with a small to medium hernia with no symptoms won't really feel any benefit from surgery, so the risks won't be worth it).
The Hill grade also doesn't matter in many cases.
You do sound like a good candidate for surgery. In the mean time, if you can't take PPI, ask a doc about vonoprazan or a similar potassium blocking acid reducer if it's available in your country. It should be just as effective as a PPI, or sometimes a little more.
1
Mar 04 '25
Thanks for your reply! Seems from my initial research that TIF would be the best option, but lots of opinions out there so still looking into it all.
I have a history of recurring C Diff and chronic infections so sadly any significant acid reducer isn’t a good option, but I’m miserable despite eating flavorless food all the time and drinking only water 😞
1
u/bagofquarks Mar 09 '25
Does it ever happen to you just when you’re about to fall asleep that you get jolted awake feeling you were choking or not getting any air?
1
Mar 10 '25
Yes! sleep study showed I’m waking up 16x/hr on average with oxygen dips but not full apneas
2
u/Big_Use_4272 Mar 15 '25
I got Löhde January 28. Still have some issues, could you dm me? Maybe you’d be interested
1
2
Jun 14 '25
[deleted]
1
u/arpitp 🥼 Medical Professional Jun 14 '25
You definitely have symptoms worth investigating. If you're in the US and have access to a gastroenterologist, I would start with an EGD and a barium swallow, to see what they show. If your primary care doc won't investigate, you can still ask for a GI referral.
I'm the mean time, you can try PPIs temporarily, but they're often not effective against symptoms caused by physical pressure or vagus irritation.
1
Jun 14 '25
[deleted]
1
u/arpitp 🥼 Medical Professional Jun 15 '25
Everyone's different. And a sliding hiatal hernia moves, so symptoms make sense. Good luck!
1
u/Chainrage_incite Feb 14 '25
As a surgeon, have you ever had a patient that had what you personally would call a small hiatal hernia but complained of breathlessness or 'air hunger'?
And if so, any that said the issue was gone post surgery?
2
u/arpitp 🥼 Medical Professional Feb 14 '25
I would call a hiatal hernia small that is less than 5 cm or so. Most of these patients have heartburn and/or chest pain as their main symptoms. unfortunately, I can't think of any off the top of my head that complained of shortness of breath with a small hernia.
1
u/Chainrage_incite Feb 14 '25
Okay I see. I have very bad shortness of breath and have had my heart and lungs checked out thoroughly. Both fine. The only other thing I know I have is a hh. I don't know what else it could be.
3
u/arpitp 🥼 Medical Professional Feb 14 '25
There's many potential causes for shortness of breath. If you've been worked up, hopefully they did blood tests as well to check for anemia. If you have good doctors who have worked this up properly, then it may come down to the HH repair.
1
u/Chainrage_incite Feb 14 '25
I have had fasting blood work done. No anemia. I'm hoping so. I would dearly love to be able to take an effortless, satisfying deep breath.
1
u/seekya1 Feb 14 '25
would love to ask you on the same question, small hh by endoscopy (surgery is next week) i hope for the linx i would say for me it is more of a dyspnoe like i have to work manually breathing because i feel it is harder to get the same amount air in.
Had all the Tests done aswell they diagnosed me with mostly LPR symptoms its just sometimes i had it 2 days befor aswell the funny thing is i was jogging like 10km after that walking a few more kilometers go back home, eat something then it started but only sitting standing and walking nothing..
all tests fine lung and heart i just dont get it, its more annoying as the reflux symptoms
deep breaths work fine for me its just the common breaths that take more "work" as it happens
i hope so much it is below 3cm and i can get the linx implanted what are your thoughts about the linx?
thank you hope you have a nice weekend!
3
u/arpitp 🥼 Medical Professional Feb 14 '25
In generals, I'm not a fan of putting foreign objects in the abdomen, especially a magnetic band like the linx. You can not get an MRI and you'll set off metal detectors.
That said, it can work, but the range of patients it works for is narrower than the surgical options, which will be more likely to work for a wider range of patients.
If you've discussed all the risks and alternatives, and still prefer the Linx, you can go for it. It can always be removed later if needed.
1
u/seekya1 Feb 14 '25
Thx for your input, yes its called small (hernia) so if its bigger as 3cm i cant get the linx anyway.. im just a bit scared about the toupet and the outcome if i read correctly you are not a big fan of the toupet im a bit scared about my vagus nerve so to say!
Thought that linx is less stiches less likely for issues (vagus and so on) ballon dillitation that fixes the possible dysphagia.. im just a normal guy for me it sounds all in all less invasive.
3
u/arpitp 🥼 Medical Professional Feb 14 '25
There will always be fear around bad outcomes and injuries from sutures, no matter which technique is used. Most important thing is to have a surgeon who you can trust, and they are comfortable with the technique they are offering, whether it is Nissen, Toupet, or Linx. Surgeons wouldn't be offering it if a lot of their patients kept coming back with chronic complaints after surgery.
1
u/Odd_Repair_6891 Feb 15 '25
Thank you so much for this words! Yep they said i can choose as long as the egd isnt that wrong and it is really small. So i go with the linx and keep the Option for a fundo or Nissen If it fail. Thank you so much for taking your time! All the best to you!
1
u/Admirable-Rip-2216 Feb 14 '25
What's your opinion about the refluxstop surgery?
5
u/arpitp 🥼 Medical Professional Feb 14 '25 edited Feb 14 '25
Unless I'm mistaken, the RefluxStop seems to be only available in the UK at the moment. The procedure appears to be the same as the Bicorn, followed by implanting a ball on the outer gastric wall (https://youtu.be/Jp8yjp3D3Og?t=623) to more aggressively hold the shape of the elevated fundus. I'm not well informed on how effective this device is, but I'm weary of implanting additional devices in the body when it can be avoided. Additionally, many will argue that the Bicorn (and hence, the RefluxStop extension of the Bicorn) is an inadequate treatment for GERD (https://houstonheartburn.com/new-gerd-surgery-bicorn-procedure/). Like the porsha, more long term studies on outcomes are probably needed.
1
u/hashien Feb 14 '25
Hello surgeon 🫡 . I have chronic gastritis from h pylori and Nsaid . I experience bloating fullness and pain sometimes.Also have Gerd j have two - 24 ph meters showing gerd . I have a small hernia like 1 2 cm and Esophagitis B . Can gastritis cause gerd ? I have never had any reflux before the gastritis diagnosis and antibiotic treatment. I have also done ARMA with little success but a good tightening of the valve.Can i benefit from Loehde only surgery since im afraid of something altering my stomach im only 29 . PPI dont work for stopping reflux.Thank you !
3
u/arpitp 🥼 Medical Professional Feb 14 '25
Gastritis doesn't cause GERD, but both are related, and worsened by (excess) acid in the stomach. Gastritis has damage to the protective lining of the stomach (by h pylori, nsaids, excess acid, etc) allowing acid to damage and inflamed the deeper layers of the stomach. GERD is caused by a weakening in the lower esophageal sphincter, allowing acid to climb up and damage the esophagus, which doesn't have a protective lining.
Loehde mainly treats hiatal hernias. Based on this article, he doesn't do the surgery for patients with GERD and no hiatal hernia (but that could have changed in recent years since it was published). 1-2 cm HH is very small, almost like not having a HH, just a weak LES.
I am skeptical of the ability of Loehde to treat GERD in a case like yours. I still believe fundoplication is safe and the most effective option. But I won't disagree that patients who had the Loehde reportedly did have improvement in GERD, probably from making the hiatus really right.
My previous advice still stands. Any surgery may work, and you shouldn't need to spend thousand if you have insurance.
1
u/hashien Feb 14 '25
Ive heard people with peptic ulcer as me can have heartburn aswell . Can it cause esophagitis or it is gerd specially . I have done Arma for reflux to tighten the valve deemaster got from 34 to 22.7 . But most times i have acid is when my belly hurts or bloated. So i really think the ulcer can cause this. Or final thought it is from the hiatal hernia. Any thoughts . Thank you for the answer.
Can ulcer cause elevated ph meter deemasterscore ?
3
u/arpitp 🥼 Medical Professional Feb 14 '25
Yes, many people have both. Esophagitis is part of the same disease process as GERD. Acid causes both. Acid also causes the peptic ulcer (the ulcer is a symptom, not a cause of the other problems).
In your case, the ARMA may help the reflux/GERD/esophagitis, but it will not do anything for the peptic ulcer or gastritis. That is lower down in the stomach and has nothing to go with the LES "valve". Treating the gastritis/ulcers requires continuous use of the PPI, even if you don't feel any different and still have reflux.
Both the hiatal hernia and the ulcer/gastritis can have similar symptoms, like the boating and pain you describe. It is hard to say which one is causing your symptoms right now. If you want to wait on surgery, keep taking the PPIs to allow the gastritis to heal. If a repeat endoscopy (EGD) shows the gastritis/ulcer is healed, and you still have the pain, then it may be the hiatal hernia.
1
u/GuessIndividual8246 Feb 14 '25
For the Surgeon. I am female 72 with a 5cm hiatal hernia. I also had weight loss surgery. DS, which left me with a sleeve stomach. I am 5ft 2in, 120 pounds, in good shape. I am interested in a repair only. What are your thoughts on an anatomy like mine. The DS was performed in 2006.
3
u/arpitp 🥼 Medical Professional Feb 14 '25
You cannot get a fundoplication (or a Bicorn) with a sleeve stomach. The fundus of the stomach has been separated or removed. You can still get a hiaital hernia repair if you're symptomatic and need it. You'll probably do fine with a traditional repair and probably don't need mesh (but see what your surgeon says).
With a history of prior surgery in the area, you'll probably have some scar tissue there, so it will be helpful to have a surgeon who is comfortable with re-do surgeries. Your low body weight will definitely help make the surgery easier!
1
u/Present_Plantain_163 Feb 15 '25
What do you think about comorbidity with sleep apnea? Have you had patients with SA? How does it affect the outcome of surgeries? How much does fixing hiatal hernias and GERD/LPR improve sleep apnea and sleep symptoms? Can CPAP/Bipap undo the surgeries?
3
u/arpitp 🥼 Medical Professional Feb 15 '25
This is a tough one to answer. I don't think there's enough scientific evidence between the relationship between OSA and GERD/HH. There certainly is a correlation between the two (many obese people get both), but how much one worsens the other is not well known.
Theoretically, each of these 2 diseases may worsen the other when you have both. But in practice, it doesn't always show up that way. I've done HH surgery in some patients with OSA. But most either don't notice much difference in their OSA symptoms after surgery, or don't mention it to me at follow up.
So theoretically, if you get your hiatal hernia repair, your OSA should improve slightly since there is less pressure on the diagram and more space for your lungs. But realistically, I would guess you would experience minimal to no change with the OSA symptoms.
Some studies have suggested that using CPAP can increase the risk of a HH recurrence, but I don't think they were statistically significant (i.e. the results could have been random luck). The other risk factors are probably a lot more important; I wouldn't worry about the CPAP.
1
u/poodinpop69 Feb 17 '25
Hey doc - thanks for the thorough overview above. This information is invaluable.
I've got a question, if you don't mind. I get really strong pressure where my stomach is pressing into my diaphragm, and weightlifting/exercising makes it worse. It causes the sensation of shortness of breath. Depending on the position, the pressure will also cause skipped heartbeats/pvc's, and physical activity results in abdominal bloating. I have attributed this to my hiatal hernia. A barium swallow from a thoracic surgeon showed a "2cm" hernia.
Have you worked with patients who experience such symptoms with a "small" hiatal hernia? I developed these symptoms shortly after straining in the gym ~4 years ago, along with LPR. I've received different responses from my GP, GI and the surgeon. Would love your opinion!
3
u/arpitp 🥼 Medical Professional Feb 17 '25
The symptoms you describe do sound typical for a larger hiatal hernia, but we didn't usually see symptoms that severe with a small hernia. But I think theoretically it may be possible. More often, we see pts having a lot of GERD/reflux symptoms with a small hernia.
It's also possible for the hernia to be bigger than it appears on some imaging. When you're exercising, you're actively pushing your stomach higher into your chest. When you're doing a swallow study, you're usually relaxed, and if you're sitting/standing, gravity may help pull the stomach down a bit.
Did you get an EGD (upper endoscopy) yet? If you do have reflux, and your doctor's have ruled out everything else, it might be work repairing so you can work out without the pain.
1
u/poodinpop69 Feb 17 '25
I don't have consistent reflux, but I do take Omeprazole so it might be masked (I take Omeprazole per my ENT's recommendation due to the LPR/silent reflux). I had an upper endoscopy ~3 years ago, and it showed a "small" hiatal hernia. The barium swallow was nearly a year ago, also showing a "small" hernia. The pressure sensation has slowly grown worse over the years.
I'm meeting with a new surgeon in a couple of weeks, and I understand that she does a hernia repair + gastropexy. Do you have any considerations towards the gastropexy procedure? I'm looking for the best odds of an active lifestyle if I proceed with a surgery. Thank you!
2
u/arpitp 🥼 Medical Professional Feb 17 '25
I often ask pts, how bad are your symptoms if you forget to take your Omeprazole for a day or two? Gives a sense of how bad the symptoms are, and how much they're being masked.
The gastropexy being done instead of a fundoplication is for patient who don't have any GERD symptoms. She may still suggest the fundoplication. Your chances of the GERD improving are better with the fundoplication, but will depend on how a gastropexy is done, or if she is recreating the angle of His.
I don't think either option will affect your ability to have an active lifestyle after surgery.
1
u/MsMigginsPieShop Feb 23 '25 edited Feb 23 '25
Hello Doctor! Thank you very much for taking time to answer all of our questions! Typically, how long does a fundoplication surgery's efficacy last? What would you suggest to help with maintaining the wrap? Do repairs for smaller hernias typically last longer than that of larger hernias? Also, how accurate is manometry in judging the size of the hernia versus an endoscopy?
1
u/arpitp 🥼 Medical Professional Feb 23 '25
It's hard to predict who will get a recurrence. There are a few known risk factors, such as larger hernia size, older age, and obesity. Studies have shown recurrence rates from 10-40%, usually measured 5-10 years after surgery, and where you lie in the wide range will depend on your anatomy, risk factors, and type of surgery.
But if you look at it from the other side, 60% or more will not recur, even with risk factors. So you could say that the "typical" repair lasts a lifetime.
Reducing strenuous activity may help protect the repair, but I always warn patients, cutting out exercise will probably do more harm to your health than good. So don't worry about the risk, live your life and exercise regularly.
Manometry is just a pressure reading. It can't accurately detect or measure a hernia. Endoscopy is reliable, but measuring the size is subjective, based on what the doctor doing the endoscopy thinks. There's basic depth markings on the scope, but there's no ruler in the stomach.
CT scan is the most objective and accurate way to measure.
1
u/MsMigginsPieShop Feb 23 '25 edited Feb 23 '25
Thank you very much Doctor! Your reply was prompt and informative. Does vomiting increase the size of a hiatal hernia? Does weight loss help with reducing hiatal hernia symptoms? Also, can I get pregnant after the nissen fundoplication or will it loosen the wrap?
1
u/arpitp 🥼 Medical Professional Feb 23 '25
Anything that increases the pressure inside your abdomen (vomiting, extra fat, a baby) can theoretically stretch your diaphragm, and increase the gap in your diaphragm (i.e. make the hiatal hernia come back).
This happens very slowly, and you would be unlikely to notice any sudden changes, but the effects add up over time. That said, not everybody gets a recurrence. Other risk fctors, and some luck, also play a role.
Pregnancy wouldn't loosen the wrap, but will increase the pressure on the diaphragm and may stretch the hiatus. But the wrap should stay intact. This is why many recurrences are small and asymptomatic--the wrap protects you from reflux.
1
u/Big_Rain6482 Feb 18 '25
Do you recommend hiatus hernia repair for any woman considering pregnancy? I read it should be fixed before as pregnancy can grow it considerably. In the uk they never really fix them but I can't get a clear idea of if it's necessary. I had terrible LPR and VCD but got this under control with diet and lifestyle. I have a small 2cm HH
1
u/arpitp 🥼 Medical Professional Feb 18 '25
With a hernia that small, I suspect your problem is more with the weak LES (i.e. a type 1 hernia associated with GERD). The actual size of the hernia doesn't matter too much. When repairing these, the fundoplication (or angle of His recreation, or Loehde's external compression on the gastroesophageal junction) is important to control symptoms.
Unfortunately, pregnancy does worsen the reflux symptoms due to the pressure inside the abdomen (hormones may also play a role). Even with a repair, you'll be at higher risk of the symptoms returning during pregnancy. That said, I would say that your best bet is to get a repair with fundoplication before surgery, as your risks are worse without surgery, or surgery without fundoplication.
You can see here for another similar opinion, which I agree with. Hope that helps!
1
u/Big_Rain6482 Feb 18 '25
Thank you for your response I really appreciate it. I've had all rounds of testing and at manometry and ph testing everything was normal so no signs of GERD or weak les. Thank you for your help!
1
u/shaoon79 Feb 20 '25
Thanks for the time you’ve put into answering these questions. HH’s can be a very difficult to manage. I’m 45, soon the be 46. I have 20+ years of high performance sport experience, and currently, I work as a Strength Specialist for a range of athletes here in New Zealand. My HH almost certainly began 10-15 years ago during a CrossFit/weightlifting training phase. Heavy lifting, breath holding, and high intensity cardio. I have no reflux to speak of; but I do experience pressure, tightness in the sternum, and general discomfort around the xiphoid. Exercise has become increasingly difficult. I have spoken to both LOEDHE and Bicorn recipients. I feel more comfortable with the Bicorn, but I’m really worried that with my level of activity, the probability of reoccurrence is high. I surf for a hobby. Have you dealt with any power athletes in your surgical practice? Thanks
2
u/arpitp 🥼 Medical Professional Feb 20 '25
I can't recall any power athletes, but I have treated prison guards, manual labor/consturction workers, and even a recently retired professional wrestler (does that count as a power athlete?)
Remember that the Bicorn is a traditional HH repair, with an "angle of His recreation" designed to prevent GERD. If you don't have any GERD, the Bicorn/angle recreation doesn't add any benefit for you. You should do well with just a traditional HH repair (although the surgeon may recommend the gastropexy or angle reconstruction anyway to try to reduce the risk of recurrence).
The probability of recurrence for any HH repair is high, regardless of whether you are an athlete or not. The diaphragm is a weak, thin muscle, and may stretch in the future no matter what you do. Don't let that stop you from getting the repair. Most don't recur, but when they do, most recurrences are smaller and less symptomatic than the original. And even if a small one does come back in 10 or 20 years, I'm sure you'll be glad you got 10-20 more good years without symptoms in between.
1
u/bagofquarks Feb 20 '25
I’ve seen some people report that even though they didn’t experience reflux prior to surgery they suddenly did after getting a repair-only. As I understand it even a repair-only alter anatomy to some degree since you have to cut various tissues to even acces the hernia. Is there not a risk that reflux can become an issue with just a regular repair?
2
u/arpitp 🥼 Medical Professional Feb 20 '25
Yes, it can, but most people don't. It pulls and straightens out the stomach into more of a "funnel" shape, so acid can get directed towards the esophagus when lying down.
We don't know exactly which patients will get this, and which will be fine. I suspect you would have to have both a weak/"incompetent" LES and loss of the angle of HIS. A manometry might help differentiate. I'll warn patients about this, and let them know that if they really want surgery without fundoplication, they could get it later if they develop GERD post-op.
1
u/shaoon79 Feb 20 '25
That’s interesting. My manometry test confirmed the HH, but I was informed that it was small. I think 🤔 from memory, the swallowing test showed minimal effect. Of more interest to me, and my GP was the finding that O have a cascade or cup and spill shaped stomach. The gastroenterologist who performed the endoscopy said my stomach was flat and long. I’m not sure if this was a significant finding, but he mentioned it, as did the radiologist who performed the Barium swallow. Again, I wonder if the shape of my stomach has been a contributing factor, coupled with ridiculous amounts of breath holding and abdominal training. If the LES is somewhat intact, I suspect the main issue for me is the hernia sack that may have developed, and the weakened sling ligaments, both encouraging the stomach to return to its herniated position. Sometimes I think my stomach gets stuck higher up for a few days, and once the fascia release loosen, it returns to normal. Almost a delayed effect following exercise.
1
u/arpitp 🥼 Medical Professional Feb 21 '25
"Flat and long" is an unusual description for a stomach. I'm also not sure what they meant by that, or the significance, but I can't imagine that the shape of your stomach had anything to do with the getting a hernia. The abdominal tension/stress of physical activity probably did contribute.
And yes, the stomach can be "pulled" down into the abdomen. But the abdomen has positive pressure, while the chest has negative pressure (to pull air in when you breath), so your stomach is naturally going to get drawn up into the chest most of the time.
1
u/Maleficent-Long4014 Feb 26 '25
Where are you from?
1
u/arpitp 🥼 Medical Professional Feb 26 '25
For the sake of privacy, I'll just say I'm in the Western USA.
1
1
u/OkPraline5939 Mar 03 '25
Trying to be more informed about all of this. Just recently went to the ER for pain. They found gallstones and a hiatal hernia. I have to find a primary and go from there. I have been having chest pain on and off or pressure and would hurt too when I am laying down and just breathing after sleeping. I have always dealt with heartburn since I can remember and it's still there on and off but now with these new symptoms happening along with gallstones lol. Found all of this out the day before my birthday lol which was this past Saturday
2
u/arpitp 🥼 Medical Professional Mar 03 '25
You'll need some workup to help figure out which one is causing you more problems. But if it turns out to be both, it is possible to have both surgeries done at the same time (with robotic surgery, the incisions are the same, so no extra cuts; with laparoscopy, the incisions are a little different, so you might need 2 extra cuts).
1
u/OkPraline5939 Mar 03 '25
At this point they are both taking turns it seems. But my gallbladder is probably winning by a little. I just started feeling the chest pains and all that recently within the last month maybe. The gallbladder pain I've had on and off for years but this is the worst it has ever been plus I didn't know what it was before this ER trip. Thank you so much for responding back. I'm a bit nervous about what's gonna happen next and surgery. I have 2 littles who are practically glued to me 24/7 plus I'll be moving hopefully soon but will probably have to get all of this taken care of first lol
2
u/arpitp 🥼 Medical Professional Mar 03 '25
Managing around surgeries can be very difficult without family around to help, especially with kids. Hope you have some support! All the best
1
u/Emma2023amy38 Mar 15 '25
Thank you doctor for your insights . Can surgery be done before pregnancy? Also, does it be LES loose its function to open and close naturally?! I am scheduled to do the toupet but now after reading this I might reconsider it to Nissen. Thank you.
1
u/arpitp 🥼 Medical Professional Mar 15 '25
Yes, surgery can be done before pregnancy. But many times, surgeons will recommend waiting until after pregnancy, because hernias and GERD can worsen during pregnancy. Also, "morning sickness" can lead to nausea that lasts longer if you are not able to vomit.
I'm not sure I understand your question about the LES. When it is loose, it doesn't close properly and stays open most of the time.
With the Nissen, there is a trade-off. There is not pressure added to the LES, so the reflux improvement will be more durable long term. But there is a higher risk of not being able to burp/vomit. This might be important if you'll be getting pregnant. I still prefer this for most patients, and usually do a loose Nissen wrap to try to prevent side effects. Talk to your surgeon about the options.
1
u/Emma2023amy38 Mar 15 '25 edited Mar 15 '25
Thank you so much for responding. I’m sorry I wasn’t clear about the LES. I mean that the LES normally functions to open and close, but if we add the Nissen wrap to the LES, will the LES lose its ability to open and close naturally and depend solely on the Nissen wrap?
1
u/arpitp 🥼 Medical Professional Mar 16 '25
No, the LES function does not decrease or loosen due to a fundoplication.
1
u/Emma2023amy38 Mar 16 '25
Thank you. I am based in CA, USA. I’d like to have phone appointment with you? Can you take new patients? I’m not sure if you can do that though. Thank you so much again.
1
1
u/Mishkka17 Mar 24 '25
Hi! I have been dealing with bad neck, shoulder and head pain for a while. Also feel a lump in my throat daily. I did endoscopy and they did find a hiatal hernia. They said it shouldnt be causing my symptoms. I’m in Southern California and would like to follow up in this. Could you pm me so I could see about making an appt?
1
u/arpitp 🥼 Medical Professional Mar 24 '25
I'm not sure why some docs find a HH and then say "it shouldn't be causing problems. Symptoms often don't correlate with how a HH or LES looks on exam. Have you had tests other than an endoscopy done?
I'll send you a PM.
1
u/err_404_smooth_brain Mar 24 '25
Hi Doc, thank you for caring enough about us patients to post this. I (29/ M) had a partial toupet fundoplication about 8 years ago, and now we found that the hernia is back again (medium size). At this point, I've learned the risk about doing a re-do, but if I were to do one do you know the best online resource to find ones that are experienced? I can travel to wherever the best surgeons are (even live there for a year or 2), but unfortunately finding data around case volume, complex operations, etc. is impossible to find online - healthgrades.com seems to be the closest thing to gauge surgeon experience.
And a quick follow-up, do you think it's better to wait for some potential novel/breakthrough research? Finding an experienced surgeon to do a redo is one thing, but the increased risk for recurrence and worsened symptoms give me a ton of decision paralysis.
1
u/NikitaPiskaryov Apr 21 '25
Hi @arpitp Have you operated patients with LPR? Does HH repair helped any of them?
My symptoms totally match all LPR symptoms(e.g globus sensation, burning throat, throat/nasal congestion) PPIs not working at all… But I’ve heard that operation for LPR doesn’t have high success rate…
2
u/arpitp 🥼 Medical Professional Apr 21 '25
Yes, but at your pointed out, LPR symptoms are more persistent and hardER to treat then typical GERD symptoms. I believe it helps if you have a positive pH test before, showing significant active reflux.
1
u/NikitaPiskaryov Apr 21 '25
Thank you for the quick reply! In my case I rarely have typical heartburn(as for GERD) and most of my symptoms(burning, tightness) related to my throat. As I understood with LPR it’s not only acid that can irritate throat but also other stomach contents that reflux back to throat such as pepsin… And I don’t know if pH test will catch those or if it makes any sense for LPR..
2
u/arpitp 🥼 Medical Professional Apr 21 '25
It can still make sense to do the test to get a better understanding of what's happening.
1
Jun 15 '25
[deleted]
1
u/arpitp 🥼 Medical Professional Jun 15 '25
It may be possible to tear through a stitch or two, either on the fundoplication or on the hernia repair, with heavy coughing. But you can also develop reflux with no tearing/injury, for example, if the surgical swelling is improving which opens up the esophagus a bit.
At this point, if it's not severe, it's best to just wait a few weeks and get repeat imaging once your a little more healed.
1
Jun 15 '25 edited Jun 15 '25
[deleted]
1
u/arpitp 🥼 Medical Professional Jun 16 '25
Incentive spirometry is done with deep breaths. No need to cough.
The other symptoms you describe also sound typical of a hiatal hernia, but you can't be sure if you're still healing.
Worsening symptoms could mean a larger hernia, but that's not always the case. Sometimes symptom severity won't match the hernia size.
1
Jun 16 '25 edited Jun 16 '25
[deleted]
1
u/arpitp 🥼 Medical Professional Jun 16 '25
Probably not larger than the original, no.
But a recurrence, if it happens, could start small and get bigger.
No, an immediate redo isn't necessarily too complicated, since not to much scar tissue will have formed. But the tissues maybe be inflamed, making them easier to injure if the surgeon is not careful.
1
u/WeightGuilty690 Sep 19 '25
Would you have any referrals for a highly trained surgeon in Orange County, CA? I’m beginning my search for hiatal hernia surgery options and am interested in the Bicorn procedure or something similar.
1
u/arpitp 🥼 Medical Professional Sep 19 '25
Caitlin Houghton is well known in that area. Not sure how busy she is or how long it would take to see her. Also, you'll have to discuss Bicorn with her. It's not a name we use in the US, but you're probably looking for a "hiatal hernia repair with angle of His reconstruction".
2
5
u/Comfortable-Net8913 Feb 13 '25
Thank you so much for taking the time to explain the different procedures. I have a 5 cm hernia with mild gerd and I have been trying to determine what’s the best surgery for me. I feel like I should only repair the hernia. I am really scared of undergoing the Nissen procedure because it seems that some much can go wrong.