HEARTBURN
A burning feeling behind the breastbone, often after eating or when lying down.
חזרה לשירותיםLAPAROSCOPIC FOREGUT SURGERY
בקע סרעפתי ורפלוקס
Anatomical hiatal repair and individualised reflux control, with careful preservation of swallowing function.
LAPAROSCOPICCRUROPLASTYNISSEN / TOUPET
לצפייה בניתוחיםלתשומת לב: הניווט בעמוד זמין בעברית. התוכן הרפואי המפורט בעמוד המקצועי מוצג בשלב זה באנגלית.
ELIXIS · ADVANCED CARE
Two goals: restore anatomy and control reflux while preserving function
Endoscopy, imaging and, when needed, manometry and 24-hour pH monitoring, with or without impedance, help guide the appropriate treatment.
תסמינים
Symptoms that merit assessment
A hiatal hernia is an anatomical displacement of part of the stomach into the chest and may cause no symptoms. Gastro-oesophageal reflux is a separate condition that often coexists and causes many of the typical complaints.
REGURGITATION
Food or sour, bitter fluid coming back towards the mouth.
DIFFICULT SWALLOWING
A sensation that food sticks or pain when swallowing.
CHEST DISCOMFORT
Pressure or pain behind the breastbone or in the upper abdomen that needs appropriate assessment.
EARLY FULLNESS
Bloating, belching, nausea or feeling full after a small meal.
COUGH OR HOARSENESS
Chronic cough, hoarseness or throat irritation, particularly at night.
Symptoms alone prove neither a hiatal hernia nor reflux. Depending on the case, endoscopy, imaging, pH monitoring or manometry may be needed.
ניתוחים
Hiatal-hernia procedures
Hiatal closure and the antireflux procedure are planned as one functional reconstruction.
01TYPE I
SLIDING HIATAL HERNIA REPAIR
Return of the gastro-oesophageal junction below the diaphragm and repair of the hiatus.
- מתי נשקל
- Objectively confirmed reflux with persistent troublesome symptoms despite appropriate treatment or with complications, and selected large hiatal hernias.
- מה כולל
- Oesophageal mobilisation, reduction, crural closure and a selected antireflux procedure.
02TYPE II–IV
PARAOESOPHAGEAL HERNIA REPAIR
Reduction of the stomach and any organs displaced into the chest.
- מתי נשקל
- Symptomatic large paraoesophageal hernia, obstruction, anaemia or concern for volvulus. A truly asymptomatic type II–IV hernia may be monitored after shared decision-making.
- מה כולל
- Sac dissection, restoration of intra-abdominal oesophagus and hiatal closure, with gastropexy or an antireflux procedure only when indicated.
03CRUROPLASTY
POSTERIOR CRUROPLASTY
The diaphragmatic crura are reapproximated around the oesophagus without excessive tension.
- מתי נשקל
- An enlarged hiatus during surgical repair.
- מה כולל
- Calibrated posterior suture closure; mesh reinforcement is used selectively rather than routinely.
04360°
NISSEN FUNDOPLICATION
A 360° wrap around the lower oesophagus to reinforce the antireflux barrier.
- מתי נשקל
- Selected reflux disease with suitable oesophageal motility.
- מה כולל
- A short, tension-free wrap after complete anatomical restoration.
05270°
TOUPET FUNDOPLICATION
A 270° posterior partial wrap balancing reflux control and swallowing.
- מתי נשקל
- Selected patients in whom a partial wrap is preferred based on functional assessment.
- מה כולל
- The fundus is fixed posteriorly and to the sides of the oesophagus without a complete wrap.
06REDO
COMPLEX OR REDO HIATAL REPAIR
Specialist reconstruction for major recurrence or failure of a previous procedure.
- מתי נשקל
- Recurrence, wrap migration, dysphagia or complex anatomy after previous surgery.
- מה כולל
- Adhesiolysis, careful definition of the altered anatomy and tailored reconstruction, with gastropexy or reinforcement where appropriate.
הדמיה אנטומית מקורית וריאליסטית לצורכי לימוד — אינה צילום מטופל.
תכנון ובטיחות
Functional assessment before the surgical decision
A hiatal hernia on a test is not by itself an indication for surgery. Symptoms must correlate with anatomy and function, while mesh or gastropexy is considered selectively.
ENDOSCOPY
Assessment of oesophagitis, stomach and anatomy.
FUNCTION
Manometry and 24-hour pH monitoring ± impedance when they affect management.
TENSION FREE
Adequate intra-abdominal oesophageal length and calibrated closure.
SWALLOWING
Wrap selection is tailored to function.
שאלות
שאלות נפוצות
תשובות קצרות לפני הערכה כירורגית אישית.
01Is a minimally invasive approach always possible?
No. It is chosen when safe and meaningfully beneficial. Anatomy, previous surgery and complexity may require another approach or conversion.
02How long does recovery take?
Recovery varies with the procedure, disease severity and general health. The individual plan covers mobilisation, diet, work and exercise.
03Will I stop reflux medication immediately?
Not necessarily. Postoperative medication and diet are individualised and reviewed during follow-up.
ראיות קליניות
ראיות קליניות
הבחירה הסופית מבוססת על התמונה הקלינית, האנטומיה וההנחיות העדכניות.
01SAGES · Surgical Treatment of Hiatal HerniasOfficial clinical practice guidelineמקור רשמי02SAGES · GERD Surgical TreatmentGuideline for surgical treatment of refluxמקור רשמי03NHS · Hiatus HerniaSymptoms and when to seek medical assessmentמקור רשמי04NIDDK · GER & GERD in AdultsSymptoms of gastro-oesophageal refluxמקור רשמי
המידע מיועד להסברה ואינו מחליף בדיקה רפואית. יתרונות, סיכונים וחלופות נידונים באופן אישי.
הערכה כירורגית אישית
הניתוח הנכון מתחיל בהתווייה הנכונה.
בפגישה נבחנים התסמינים, הבדיקות והחלופות.
מרפאת REA MED והגעה