A Laparoscopic Surgery Giving Patients a New Lease on Life

In July, Cheryl Koch, 74, of Florissant, Mo., was eating at a restaurant when she noticed her food wouldn’t go down. Concerned, she returned home. Her chest was tightening, and her blood pressure was alarmingly high. Her neighbor called 911, and the paramedics told her she needed to go to the emergency room (ER) right away.

After arriving at the ER, a number of tests were performed including an upper endoscopy. The endoscopy showed Cheryl’s stomach was ischemic, meaning it wasn’t getting enough blood. This life-threatening situation was the result of a strangulated hiatal hernia. A hiatal hernia is when some or all of the stomach goes up into the thoracic cavity, or chest. In Cheryl’s case, it had cut off the blood supply to her stomach.

Cheryl had been diagnosed with a hiatal hernia many years ago, but she didn’t realize how much it had progressed. It only caused her problems every once in a while, and never at this level of severity. Her father also had a hiatal hernia, and Cheryl remembers it being a rough surgery those many decades ago. For those reasons, she hadn’t sought out treatment yet.

Placed under the care of Shuddhadeb Ray, MD, MPHS, a Washington University cardiothoracic surgeon that joined the Christian Hospital team last summer, Cheryl underwent a minimally invasive hiatal hernia repair surgery. Dr. Ray’s laparoscopic approach involves just five small incisions and ports, all less than one centimeter in size. Using small instruments and a camera, Dr. Ray and his team, assisted by his colleague and fellow surgeon Varun Puri, MD, MSCI, were able to reduce the hernia and the size of the hole in the diaphragm in which the stomach went up into the chest. They then did a small wrap to prevent the stomach from going back up and to prevent reflux. Her surgery went very well, and both Dr. Ray and Cheryl are very pleased with her outcome.

Dr. Ray and his team have seen great success with this procedure, as it can also be performed electively. “Their surgery is generally only about two to three hours long. They stay for about two days in the hospital. They’ve done very well overall in terms of their symptoms, which is a relief from regurgitation, reflux and pain, and a majority of them can get back to their daily activities quite quickly,” explains Dr. Ray. In Cheryl’s emergent case, her stay in the hospital was only a few days longer.

“Had I known that this was as simple as it was, I probably would’ve done it sooner. It was a very quick recovery. It was a real blessing,” says Cheryl. “I think I got a miracle on this one. I really do.”

Now Cheryl is doing well. She goes to the gym a few times a week and enjoys walking with friends. She can eat without getting sick, has much more energy and has even been able to cut back on her diabetic medicine. She encourages anyone with a hiatal hernia to see Dr. Ray sooner than later. “They could have the surgery and not have to worry about getting sick.” She adds, “I got excellent care when I was in the hospital. They were very, very attentive. I couldn’t ask for better care actually.”

Likewise, Dr. Ray encourages patients to seek out care before it becomes emergent. “Many people don’t know that they have a hiatal hernia because they are asymptomatic. Other people have symptoms such as reflux, abdominal or chest pain, regurgitation or difficulty breathing or swallowing,” says Dr. Ray. “If there is evidence of a hiatal hernia and they have any of those symptoms, it’s worth being evaluated by a surgeon.”

He continues, “It is generally a low-risk procedure that allows people to have their symptoms addressed and usually reduces their reliance on proton-pump inhibitors, or medication for reflux. And most importantly, it can prevent it from becoming an emergent situation.”

To learn more about hiatal hernia repair or to schedule an appointment with Dr. Ray, please call 314.747.WELL (9355).

HIATAL HERNIAS BY THE NUMBERS

• 75% of hiatal hernias occur in females over the age of 70
• 1-2% risk per year of developing acute issues requiring emergency surgery
• 15% risk per year of progressing from asymptomatic to symptomatic
• 2-hour length of surgery* 2-day stay in the hospital in most cases

MOST COMMON SYMPTOMS

• Difficulty swallowing
• Chest or abdominal pain
• Reflux
• Regurgitation