Diaphragmatic Hernia Surgery in Ankara, Turkey

Diaphragmatic hernia surgery is a surgical procedure performed to prevent the stomach or intestines from slipping into the chest cavity. It is especially preferred for large hernias that cause reflux. With treatment, both the anatomy of the organs is corrected and complaints decrease.

In diaphragmatic hernia surgery, the laparoscopic method is frequently used. Since this technique is performed with small incisions, the recovery time is short. It also reduces the length of hospital stay and postoperative pain is minimal.

In the postoperative period, it is important to regulate dietary habits. Patients are fed with liquid foods in the first days, then transition to soft foods is made. Quitting smoking and alcohol supports treatment success.

Long-term follow-up after diaphragmatic hernia surgery prevents the recurrence of reflux complaints. With regular check-ups, the risk of hernia formation again is evaluated. Lifestyle changes increase the long-term effectiveness of the surgery.

You can contact Prof. Dr. Ebru Soy, one of the doctors performing Diaphragmatic Hernia Surgery in Ankara, to get information about Diaphragmatic Hernia Surgery prices, the process, and the hospital where Diaphragmatic Hernia Surgery is performed.

What Is a Diaphragmatic Hernia?

A diaphragmatic hernia is a condition in which part of the stomach slips into the chest cavity through a natural opening in the diaphragm. The most common form is a hiatal hernia, and it usually causes stomach contents to flow back into the esophagus (reflux).

What Is Diaphragmatic Hernia Surgery?

If we think of our body like a two-story house, the diaphragm is a strong, dome-shaped muscle that separates the chest cavity (upper floor) from the abdominal cavity (lower floor). In addition to being the main muscle that enables us to breathe, the diaphragm also serves as a protective floor that prevents organs such as the liver, stomach, and intestines from moving upward into the area where our lungs and heart are located. A diaphragmatic hernia is the displacement of abdominal organs into the chest cavity due to a congenital deficiency in this muscular floor or a tear that develops later. Diaphragmatic hernia surgery is the surgical intervention that corrects this anatomical disorder, ensuring that each organ returns to where it should be.

The types of diaphragmatic hernia we encounter are generally as follows:

• Congenital Hernias
• Acquired (Traumatic) Hernias
• Stomach Hernias (Hiatal Hernia)

Congenital hernias occur when the diaphragm fails to complete its development while the baby is still in the womb and usually lead to serious problems related to the baby’s lung development immediately after birth. The most common cause of acquired hernias is severe trauma such as traffic accidents or falls from height. Such injuries may sometimes go unnoticed at the time and may cause symptoms years later.

However, in adults, the most common type we see is stomach hernias. This is the slipping of part or all of the stomach into the chest cavity as the natural opening where the esophagus enters the abdominal cavity loosens and widens over time. Complaints such as reflux, difficulty swallowing, and chest pain are often due to this condition. Regardless of the type of hernia, the goal of surgery is to solve this anatomical problem and restore the body’s normal functioning.

In Which Situations Is Diaphragmatic Hernia Surgery Performed?

The decision for diaphragmatic hernia surgery is made depending on the urgency of the condition, the severity of the complaints caused by the hernia, and how much it affects the patient’s quality of life. When making this decision, the patient’s general health status and expectations are also of great importance.

In some cases, emergency surgical intervention is required because the herniated organs pose a life-threatening risk. These emergency situations are as follows:

• Organ strangulation
• Gastric volvulus
• Bowel obstruction
• Organ perforation

Organ strangulation is the interruption of blood flow to an organ trapped in the hernia opening and can cause the organ to lose viability (gangrene). Gastric volvulus, especially in large stomach hernias, is the twisting of the stomach around itself, blocking both its entrance and exit. Both are conditions that cause severe pain and can be fatal if not treated urgently.

In situations that do not immediately threaten the patient’s life but seriously reduce quality of life or have the potential to become dangerous in the future, surgery is performed electively. Common situations requiring elective surgery are as follows:

• Persistent reflux complaints
• Difficulty swallowing and a feeling of pressure
• Unexplained anemia

If severe heartburn, bitter fluid coming into the mouth, or chronic cough due to a hiatal hernia do not respond to strong medical treatment, or if the patient does not want to use medication for life, surgery offers a permanent solution. Similarly, mechanical symptoms such as difficulty swallowing due to the size of the hernia, a sticking sensation in the chest after meals, early satiety, or shortness of breath require surgery because they cannot be corrected with medication. Sometimes, occult bleeding from small sores (Cameron ulcers) caused by the diaphragm constantly compressing the stomach can lead to iron deficiency anemia. In this case, repairing the hernia is necessary to eliminate the underlying cause of anemia.

Sometimes, a hiatal hernia may be detected incidentally during examinations performed for another reason in a person with no complaints. In this case, the approach is determined individually. In an elderly patient with additional health problems and high surgical risk, a “watch and wait” approach may be adopted if there are no symptoms. However, in a young, healthy, and active patient with a large hernia, elective surgery may be recommended to eliminate the possibility of facing an emergency and much riskier surgery in the future. This is a joint decision that the surgeon and the patient will make together by discussing all risks and benefits.

What Are the Risks of Diaphragmatic Hernia Surgery?

Like any surgical procedure, diaphragmatic hernia surgery carries certain risks. Although these risks have been reduced to very low levels thanks to today’s technological possibilities and modern anesthesia methods, it is essential that patients are informed about the process. Knowing the potential risks of surgery is an important part of the decision-making process.

First of all, there are general risks common to every surgery. These are as follows:

• Reactions related to anesthesia
• Bleeding during or after surgery
• Infection at the surgical site or in internal organs
• Blood clot formation in the leg veins (Deep Vein Thrombosis)

In addition, there are some special risks specific to diaphragmatic hernia surgery. These risks may vary depending on the complexity of the surgery and the structure of the hernia.

• Recurrence of the hernia
• Injury to adjacent organs
• Mesh-related problems
• Persistent difficulty swallowing
• Lung problems
• Bloating and gas syndrome (Gas-bloat)

Recurrence of the hernia is a possibility that can be seen especially in very large hernias or in cases where the repair is under tension. Since the surgery is performed very close to adjacent organs such as the esophagus, stomach, spleen, and liver, there is a risk of injury to these organs; however, in the hands of an experienced surgeon this risk is extremely low. In large hernias, serious issues such as rare erosion (perforation) of the mesh into the esophagus or stomach, or infection of the mesh, may occur.

In the early postoperative period, difficulty swallowing is common and is usually due to swelling in the tissues, improving over time. However, it may become permanent if the repair is made too tight. Due to close proximity to the lungs, conditions such as pneumothorax or fluid accumulation in the chest cavity may occur, and these are usually managed with a chest tube. Especially after hiatal hernia surgery, some patients may have difficulty belching and experience abdominal bloating; this usually improves with diet and over time. Your surgeon will explain in detail the risks specific to your condition and the measures taken to minimize these risks during the preoperative consultation.

How Is Diaphragmatic Hernia Surgery Performed?

Diaphragmatic hernia surgery can be performed with two main approaches: “open” or “closed” (minimally invasive). Today, the vast majority of elective surgeries are performed with closed techniques due to the comfort they provide for the patient. Your surgeon will decide which method is most suitable for you based on the characteristics of your hernia and your general health condition.

Closed (Minimally Invasive) Surgery

In this approach, instead of making a large incision in the body, the surgery is performed through several small openings with the help of special instruments and a camera. The biggest advantages of this method are less pain, faster recovery, a smaller scar, and a lower risk of infection.

Laparoscopic Surgery: This method is performed by entering through 3-5 openings of 0.5-1 cm made in the abdominal region and is considered the gold standard today. The abdominal cavity is inflated with carbon dioxide gas to create a safe working area. A high-resolution camera projects an enlarged image of the surgical area onto a screen, and the surgeon completes the operation by watching this image and using specially designed long and thin instruments.

Robotic Surgery: This is the most technologically advanced form of laparoscopic surgery. Instead of standing next to the patient, the surgeon controls the robotic arms by sitting at a console in the operating room. This technology provides the surgeon with 3D vision, superior maneuverability, and a precision that eliminates tremor of the human hand. It offers great advantages especially when working in narrow and deep areas, placing sutures, or separating adhesions in patients who have had previous surgery.

Open Surgery

In this traditional method, a larger incision is made to reach the surgical area directly. It is generally preferred in more complex or emergency situations where the closed method is not suitable.

• Laparotomy (Open Abdominal Surgery): It is generally preferred in emergency trauma cases (such as traffic accidents) because it allows the surgeon to check for other organ injuries in the abdomen.
• Thoracotomy (Open Chest Surgery): It is used especially in the repair of long-standing hernias adherent to intrathoracic organs such as the lungs, as it provides better visualization to safely separate these adhesions.

Regardless of which method is chosen, the basic steps of the surgery are the same. These steps are as follows:

• Returning the organs to the abdomen
• Removal of the hernia sac
• Repair of the tear in the diaphragm
• Reinforcement with mesh (if necessary)
• Anti-reflux procedure (Fundoplication)

First, the organs that have slipped into the chest cavity are gently pulled back into the abdomen. Then, to prevent recurrence of the hernia, the hernia sac surrounding the organs is carefully removed. The tear or widened opening in the diaphragm is closed with strong sutures. If the opening is very large and the sutures would cause tension, a mesh is used to reinforce the repair. Finally, especially in hiatal hernias, the upper part of the stomach is wrapped around the esophagus like a mantle to create a new valve mechanism to prevent reflux.

The Process After Diaphragmatic Hernia Surgery

Postoperative recovery is as important as how successfully the surgery went, and you need to take an active role during this process. The speed of recovery varies depending on the type of surgery performed (open or closed) and your personal health status, but in general it consists of certain stages.

In the hospital, you may usually need to stay 1-3 days after closed surgeries and a little longer after open surgeries. During this period, your pain is kept under control with painkillers. To reduce the risk of infection and clots, you are asked to get up and walk as early as possible. After surgery, you may have a tube inserted through your nose on the first day to relieve your stomach, and a drain may be used to remove air or fluid from the chest cavity. These are usually removed within a short time.

One of the most critical issues after surgery is nutrition. A strict diet program is applied to avoid damaging the repaired area and to allow swelling in the esophagus to heal. This process generally includes the following stages:

• Clear liquids (First 1-2 days)
• Purée-consistency foods (First 2 weeks)
• Soft, easily mashed foods (2-4 weeks)
• Slow transition to a normal diet (After 4-6 weeks)

At first, only liquids such as water and apple juice are allowed. Then, purée-consistency foods such as soup, yogurt, and pudding are introduced. In the following two weeks, soft foods that can be easily mashed with a fork such as well-cooked vegetables, minced meat, and fish can be consumed. The most important rules during this period are taking small bites, chewing very well, and eating slowly. After about a month, you can gradually return to a normal diet. Carbonated drinks should be avoided for at least one month.

If you work a desk job, you can return to work within 1-2 weeks; if you have a physically demanding job, you can return within 1-3 months. Complete internal healing and the repair reaching maximum strength takes several months. During this process, attending the follow-up appointments determined by your surgeon and following their recommendations play a key role in a smooth recovery.

What Patients Who Have Diaphragmatic Hernia Surgery Should Pay Attention To

After a successful diaphragmatic hernia surgery, it is very important to make some permanent changes in your lifestyle and follow certain rules in order to maintain this good condition and minimize the risk of recurrence. This is an investment in your repair.

First of all, you should be careful about activity and exercise. It takes time for the diaphragmatic repair to heal and strengthen. During this sensitive period, it is necessary to avoid any movement that increases intra-abdominal pressure. The most important points you should pay attention to are as follows:

• No heavy lifting
• Avoiding strenuous exercises
• Preventing straining (Constipation and cough control)

For at least 4-6 weeks after surgery, you should not lift, push, or pull anything heavier than a few kilograms. To start sports such as sit-ups and weightlifting that work the abdominal muscles, you need to wait at least 3 months and обязательно get your surgeon’s approval. The best exercise during this period is walking. Straining due to severe coughing and constipation is extremely dangerous because it puts direct pressure on the sutures. Therefore, you should take care not to become constipated and seek support from your doctor if necessary.

Dietary habits are also of great importance in both the short and long term. Especially after hiatal hernia surgery, some eating habits need to become permanent.

• Small and frequent meals
• Eating slowly and chewing well
• Not eating right before bedtime
• Avoiding carbonated drinks
• Avoiding foods that personally trigger symptoms

Instead of filling your stomach all at once, it is best to divide the day into 5-6 small meals. Chewing each bite well makes digestion easier and helps food pass comfortably through the esophagus. Stopping eating at least 2-3 hours before bedtime prevents nighttime reflux. Carbonated drinks such as cola and soda can cause sudden bloating in the stomach. In addition, you should identify and avoid foods that cause reflux or bloating for you specifically (such as very fatty, spicy, or acidic foods).