A paraesophageal hernia occurs when the upper part of the stomach pushes through an opening in the diaphragm and into the chest. Surgical repair involves returning the stomach to the abdominal cavity and reinforcing the diaphragm opening. The procedure is often performed using minimally invasive laparoscopic techniques to reduce hospital stays and morbidity. While this surgery is a standard treatment, it is a complex operation that carries risks of complications.
Immediate Post-Surgical Issues
Difficulty swallowing, known as dysphagia, is a common temporary issue following the repair. This is caused by inflammation and swelling in the tissues around the esophagus and the reconstructed diaphragm opening. For most individuals, this resolves within six to eight weeks as swelling subsides and the body adapts.
Gas bloat syndrome is another frequent complaint, causing patients to feel uncomfortably full and unable to burp. This happens because the surgical repair, which may include a fundoplication, reinforces the valve that prevents reflux. This reinforcement can make it difficult for gas to escape upwards until the body adjusts.
Pain is an expected part of recovery, with discomfort at the small incision sites from the laparoscopic instruments. A deep ache in the chest or sharp pain in the shoulder can also occur. This is referred pain caused by the carbon dioxide gas used during surgery, which can irritate the diaphragm.
Nausea and vomiting can also present in the postoperative period. These symptoms are side effects of general anesthesia and the physical manipulation of the stomach during the repair. Up to 60% of patients may experience nausea shortly after this type of surgery.
Serious Surgical Complications
A leak from the sutured or stapled area of the stomach or esophagus is a serious concern. This allows digestive fluids to seep into the chest cavity, leading to a severe infection called mediastinitis, characterized by intense pain, high fever, and a rapid heart rate.
There is a risk of unintentional injury to adjacent organs. The nearby spleen can be damaged, leading to bleeding. Perforations in the esophagus or stomach can also occur, with reported rates between 1.5% and 6.5%. A tear in the lung lining can cause a pneumothorax.
The vagus nerve, which runs alongside the esophagus, can be bruised or damaged during the dissection. Injury to this nerve can impair the stomach’s ability to empty properly, a condition known as delayed gastric emptying or gastroparesis. This can lead to persistent nausea and vomiting.
Internal bleeding and the formation of blood clots are also potential risks. Significant bleeding may require a return to the operating room. Blood clots, such as deep vein thrombosis (DVT) in the legs, can be dangerous if they travel to the lungs, causing a pulmonary embolism (PE).
Long-Term Postoperative Concerns
A primary long-term issue is hernia recurrence, where the stomach again pushes through the diaphragm. While many patients with a recurrence are asymptomatic, studies report detection rates as high as 20-30%. Obesity and activities that increase abdominal pressure can contribute to the repair failing over time.
Repairs using surgical mesh can lead to specific long-term complications. In rare cases, the mesh can erode or migrate into the esophagus or stomach, causing pain, difficulty swallowing, or internal bleeding. The mesh can also become a site for chronic infection that is difficult to treat without its removal.
While initial difficulty swallowing often resolves, some patients develop chronic dysphagia. This can result from excessive scar tissue forming a permanent narrowing of the esophagus, known as a stricture. This condition may require additional procedures, like an endoscopic dilation, to stretch the area and improve swallowing.
Dumping syndrome is a less common issue where the stomach empties its contents into the small intestine too quickly. The fundoplication procedure can alter the stomach’s anatomy and affect its storage function. This rapid emptying triggers symptoms like abdominal cramping, diarrhea, and lightheadedness shortly after a meal.
Recognizing and Managing Complications
Patients should monitor their recovery for potential problems. Contact a doctor for warning signs of a serious complication like a leak or infection, including:
- A fever over 101°F
- Chest or abdominal pain that worsens instead of improves
- An inability to swallow liquids
- Persistent vomiting
- Shortness of breath
Physicians use several tools to diagnose a suspected complication. A barium swallow study can reveal swallowing issues, leaks, or a recurrent hernia on an X-ray. An endoscopy allows a direct view of the esophagus and stomach, while a CT scan provides detailed images to identify inflammation or structural problems.
Management of complications varies by issue and severity. Mild problems like gas bloat or temporary dysphagia are managed with dietary modifications, such as eating smaller meals. More significant issues like an esophageal stricture may require an endoscopic dilation. Severe complications like a staple line leak or a symptomatic recurrent hernia may require revision surgery.