Hiatus hernia and reflux: laparoscopic fundoplication

Gastro-oesophageal reflux is the backflow of acidic stomach contents into the oesophagus. It causes burning behind the breastbone, regurgitation and sometimes cough or hoarseness. It is often associated with a hiatus hernia: part of the stomach slides up into the chest through the opening in the diaphragm through which the oesophagus passes (the hiatus). The operation is performed laparoscopically through five small incisions. The surgeon brings the stomach back down into the abdomen, narrows the opening in the diaphragm with a few stitches (sometimes reinforced with a mesh), then wraps the upper part of the stomach around the lower oesophagus to create an anti-reflux valve: this is fundoplication (Nissen or Toupet type, depending on the case). It is offered when reflux remains troublesome despite well-followed treatment, when the person does not wish to take medication for life, in case of complications (severe oesophagitis, significant regurgitation) or for a large hiatus hernia. Tests beforehand confirm that surgery is appropriate. At Clinique Pasteur Tunis, the assessment includes gastroscopy at the endoscopy centre and radiology on site; manometry and pH monitoring are prescribed as needed. The operation is performed laparoscopically, with a short hospital stay and dietary advice for the first weeks.