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asymptomatic type 4 hernia

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Posted 7/30/2012 11:58 PM (GMT 0)
I am pretty new here. I have a type 4 paraesophageal hernia, that I have had at least 10 years, if not longer. I have no symptoms, and that makes thinking about the surgery and all the after effects that much harder. I just read a report that talked about "watchful waiting", for patients who are asymptomatic. It showed very good results for taking that approach. Has anyone on this board ever not done the surgery, but instead you are just taking a very conservative approach? Thoughts?
Posted 7/31/2012 3:04 AM (GMT 0)
Hi cuicui,

Surgeons do surgery, and I understand your concern about the possibility that you're being led down a garden path toward a possibly unnecessary surgery.  From what I've read over the last few years, it seems paraesophageal hernias can create complications that could require emergency surgery.

When you say you are symptom free, I'm guessing that means you're not aware of any reflux.  I assume you had an endoscopy...did you have any evidence of reflux in your esophagus?  Did you have a 24hr PH monitor test to see how many episodes of reflux you're getting?

I would suggest you make some appointments with GI experts who aren't surgeons to see if it's generally recommended to repair the hernia, and if so, why.  I guess I'd want to know the risk-benefit ratio.

It's a tough decision, I know.

I wish you all the best!

Denise

Posted 7/31/2012 10:54 PM (GMT 0)
Are you sure you have type 4 hiatal hernia and are asymptomatic? Was this diagnosed in the beginning ten years ago? If so I wonder what type of tests they did then.

Type 1 hernias, the sliders, can be watched if they are not large, but I've always read and been told by surgeons that paraesophageal hernias need surgery.

I was really glad to get my paraesophageal hernia fixed. I could feel the stomach trying to roll, and if it had I would have died for being too far from a hospital where I could get it fixed.
Posted 7/31/2012 11:41 PM (GMT 0)
Alcie, do you feel even the sliders need to be corrected? Dr. Levy at UPMC said that I appear to have a slider, but most while a lot of people do, I have a boatload of symptoms. 2 other GI's said they didn't see a hernia in either barium swallow or endo....
Posted 8/1/2012 8:21 PM (GMT 0)
Hi, hitThePost.

Dr. Levy is really good. I think he may have done a lot of my surgery, although Dr. Luketich was the surgeon of record. In a teaching hospital you can't tell. I would believe whatever he tells you. I'd trust him to do surgery on me again.

Sliders that are causing trouble do need to be operated. They won't get smaller by themselves. Have you jumped through the testing hoops? You have to have measurable symptoms.
Posted 8/1/2012 10:10 PM (GMT 0)
Oh wow, Dr Luketich and the staff seem to be awesome. I do have a ton of symptoms and I show high PH scores as well. The only issue is that Levy is the only doc to say he sees anything, but I trust his word as they do so many Nissens and tests so they get to pick up on these things regularly.

I am still considering their staff, but I am leaning towards the LINX first, with a small hernia repair. I believe they do these still as well, but I still need to go through the steps.....
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