Category Archives: invasive paraesophageal hernia surgery
Written by Adrienne Carter (class of 2014-2015)
I arrived at Highland a little past 7:00 am. When I entered the conference room, Dr. Harken and his students were not there, so I proceeded up to the OR.
When I got to the OR, I went into room 4. The nurses were prepping for a patient undergoing a laparoscopic paraesophageal hernia.
Dr. Smith took the time to explain the procedure to me. She explained that the patient came into the ER complaining of shoulder pain. Doctors performed a CT scan. The CT scan showed that the patient had a hernia. Dr. Smith explained that there are several types of hernias. In this particular case, the patient’s entire stomach had moved all the way up past his diaphragm into his chest cavity. Dr. Smith showed me the patient’s CT scan. I was amazed to see how much the patient’s stomach had moved! The patient’s stomach was almost near his heart.
Dr. Smith explained that shoulder pain is characteristic of diaphragm irritation, which is called radiating pain.
After about 45 minutes of preparation, the patient was wheeled into the operating room. The patient was a 51 year old, Hispanic male. Dr. Schwarz who was the anesthesiologist, prepped the patient. Next, the doctors inserted the tools and a camera to perform the surgery laparoscopically. They used the tools to move his liver out of the way and to help to move the stomach down past his diaphragm. However, they had difficulty keeping his stomach in the proper place. They eventually concluded that it would be best if they did an invasive procedure instead of laparoscopic, to help them visualize and gain better access.
They removed the cameras and made a large incision down the patient’s belly. They used large clamps to hold back the patient’s skin. I was amazed at how much I was able to observe, I saw the patient’s liver, spleen and stomach. I even saw the patient’s heart pumping! Seeing this definitely made me realize how unique this opportunity is. The OR is the only place where I will ever get to literally see inside someone’s body and see how all of their organs are connected.
The remainder of the surgery consisted of the surgeons pulling the stomach into the proper place and using mesh to ensure that it did not move back in the future. The entire surgery took about 5 hours.
Since the procedure was longer than expected, I did not have time to view any other surgeries, but I felt very fortunate that I was able to observe this one.