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Paraesophageal Hernia Repair

Ilda DaMota paraesophageal hernia surgery patientThe Best Thing I Ever Did

Ilda DaMota-Dillon Viteri, 60, was eating on the train from Boston when severe pain knifed through her side and spread toward the center of her chest. As the stops along the route continued, her pain grew unbearable.

“I thought I was having a heart attack,” recalls Ilda, a Bellingham resident. “It was so strong and getting tighter and tighter. It was knocking the breath out of me. I would try to move in a different position, but it wasn’t going away. I wanted to breathe, but I couldn’t.”

When she reached Forge Park Station, she called for an ambulance. The paramedics transported Ilda to Milford Regional, where she underwent extensive testing. To Ilda’s relief, her heart was fine. However, she was shocked to discover that she was suffering from a huge hiatal hernia. Upon discharge, Ilda was referred to a gastroenterologist, who recommended that she see a thoracic surgeon. She scheduled an appointment with Dr. Daniel Wiener, a Brigham and Women’s thoracic surgeon who sees patients twice a week at The Cancer Center at Milford Regional. Dr. Wiener treats lung cancer, benign lung disease, esophageal cancer and benign esophageal disease. He explained that Ilda needed paraesophageal hernia repair.

“A hernia is a weakness or defect in the tissue of the body,” he notes. “In this case, it’s the diaphragm that’s weak. There is a natural opening that accommodates the esophagus as it passes from the chest into the abdomen. For a variety of reasons, that opening can stretch over time and things from the abdomen, most commonly a part of the stomach, can slip up into the chest. It’s very common as people age for these tissues to weaken.”

According to Dr. Wiener, chronic constipation, coughing, and heavy lifting can lead to the problem, although sometimes there are no obvious reasons. These hernias can be surgically corrected using a minimally invasive laparoscopic approach. The surgeon makes several tiny incisions in the abdomen and inserts a miniature video camera and surgical instruments. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues.

“I liked Dr. Wiener right away,” Ilda remarks. “He even drew a diagram to show what he had seen on the CAT scan. He was very straight-forward and did everything in his power to take care of me quickly.”

The most common symptom of a hiatal hernia is heartburn or regurgitation – a backflow of stomach content into the esophagus. Other symptoms can include upper abdominal and chest pain, feeling full early, and shortness of breath, explains Dr. Wiener. Sometimes, patients present with a longstanding history of iron deficiency anemia, as paraesophageal hernias can be associated with small stomach ulcers that slowly bleed. Some patients may be asymptomatic, with the hernia detected on a scan performed for another reason. In those cases, a watch-and-wait attitude is generally taken.

Ilda had noticed discomfort in her ribcage for a while. She planned to investigate her symptoms further, and then the train incident happened. According to Dr. Wiener, her crushing pain was unusual, but in rare cases a hernia can develop serious complications that can even become life threatening. If someone is symptomatic, he generally recommends surgery. While medications can help suppress the heartburn, the hernia will not go away on its own. “The surgery involves reducing the herniated stomach,” he relates. “You pull the stomach down, and there is a sac you also have to reduce. Once the stomach and hernia sac have been reduced, you narrow the opening in the diaphragm so it will only accommodate the esophagus. The biggest incision is one centimeter and the others are five millimeters. We also free up part of the stomach to wrap it around the esophagus to help prevent reflux and to help prevent the hernia from recurring.”

Surgery typically takes up to three hours and recovery is a day or two in the hospital. Dr. Wiener sends patients home on a liquid diet for two weeks and asks them to return for follow-ups at two weeks, four weeks, six months and thereafter, annually. “We tell them to lift nothing greater than a gallon of milk or ten pounds for about six weeks,” he says. “If their work doesn’t involve lifting, people can generally go back to work in two weeks or so.”

Ilda had her surgery on March 14 and went home the next day feeling much more comfortable than she had before the procedure. “I didn’t have a lot of pain afterwards,” she notes. “It was much better than before. I could breathe and it was nothing like what I had gone through. . . I really thought I was going to die. I felt so miserable."

Even though Ilda regularly travels to Boston for work, she was thrilled to have her procedure done locally. “I wouldn’t have been close to my family and it would have been a hassle. Having a Boston doctor right here was wonderful. I’m not the type of person to just put myself in anybody’s hands, but I got a good feeling about Dr. Wiener. He explained every step of the way, and I really liked his mannerisms and demeanor. At the hospital, every single nurse was kind. They were always coming in to see if I needed anything.”

Looking back, Ilda is glad she chose Dr. Wiener and Milford Regional. “I feel so much better,” she states. “The surgery is the best thing I ever did.”

Read more about Daniel Wiener, MD


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