Hiatus hernia surgery

The aim of the surgery described here is to repair a hiatus hernia (i.e. to ‘close the gap’), restoring the normal anatomy of the region and bringing the oesophagus back into its physiological (‘natural’) position. This is achieved by using a mesh implant specifically developed for this purpose. Compared to other approaches which use larger mesh implants inserted over the two limbs of the diaphragm, the mesh used here is significantly smaller and more compact. If nothing else, this also means there is less of a ‘foreign body’ left in the body.

The mesh consists of two flaps and a central bridging section. This means the hernia can be closed and further reinforced, providing higher stability and a lower risk of recurrence. The duration of the surgery depends on the individual situation at initial assessment. Around one hour is needed for the surgery on average, and it is performed laparoscopically, i.e. using a minimally-invasive ‘keyhole’ technique.

The surgical technique was developed by Dr. Eckhard Löhde PhD, who, together with his colleague Florian Thomas, a senior consultant on his team, performed the surgery from 2003 to 2014 in the DRK Hospitals in Berlin. The so-called L.OE.H.D.E approach (laparoscopic oesophago-hiatal delta-mesh enforcement) is only employed by doctors who have undergone extensive additional training in the method and have the right level of experience with using this specialist technique.

Who can benefit from surgery?

The surgery described here is generally appropriate for patients who have finished growing (i.e. not children/teenagers) and who suffer from an axial and/or paraesophageal hiatus hernia. There is an indication for this surgery if the standard surgical approach (using simple sutures) to close the cleft in the diaphragm which has become too large carries a high risk of recurrence, i.e. if it is likely the symptoms would come back.

In essence, however, a medical decision for surgical intervention must always be made on an individual basis for each patient. It is vital in this regard to take a careful medical history from each patient, and to perform comprehensive investigations prior to any surgery. The surgeon will only recommend proceeding with the operation once all the patient-specific criteria are met. The operation is then only performed after in-depth informed consent discussions have been conducted.