For a long time I’ve lived with something called a hiatal hernia. This is a situation where my stomach is pushing up through my diaphragm. This means that the opening into my stomach is above where it’s supposed to be, which leads to the classic symptoms of GERD such as acid reflux, heartburn, chest discomfort, etc.,. I also suffer from generalized anxiety disorder, which when combined with a misaligned esophagus would cause pressure and heartburn in my chest that would mimic the symptoms of a heart issues (all checked and I’m good there).
After what is probably decades of dealing with this issue I finally decided to have something done about it. The solution for a hiatal hernia is what is called a nissen fundoplication. This is a surgical procedure where they bring your stomach back down to where it’s supposed to be and then wrap the top part of the stomach around the esophagus to create a “knot” to keep the stomach from going back up past the diaphragm. They also will repair the diaphragm to help keep everything where it’s supposed to be. After a few weeks of healing you can return to normal activity and the issue should be fixed permanently.
Part of the reason that I decided to have the procedure done is that I’m not getting any younger, and the older I get, the more difficult things like surgeries are. It’s safer for me to take care of this while I’m still middle-aged and healthy, instead of it becoming a complication later in life. I also wanted to wean myself from my dependence on drugs like omeprazole, which I had been taking daily for years.
Originally this surgery was scheduled for early in 2021, but the surge in COVID cases cancelled any procedures that were not deemed completely essential. Normally, this is the type of thing I’d get done over the winter time when I’m less likely to be training for a big event or traveling a lot, but because I decided to do an early spring 100K, I had to put off the surgery until this summer. As the June date approached I became more and more frustrated that I would be giving up some prime outdoor time, but with the reassurances of my wife, I knew it was best to just get this taken care of.
Before I go much further, part of the reason I’m sharing my experiences here (and so much personal health information) is to help others who might be looking at this procedure and want to read some real world experiences. It’s hard to know what to expect with this surgery because every person’s hernia is different. The vast majority of hiatal hernias are never repaired and people simply live with any mild symptoms that occur. I was mostly in this camp, but my symptoms were just bad enough to warrant getting it fixed. In my case I had a 3cm, Type I sliding hernia. This means that my stomach would push up above the diaphragm into my chest around 3cm (sometimes more or less). This is a pretty typical type of hiatal hernia, and much less impactful than Type II-IV which is where parts of the stomach push up NEXT to the esophagus and can cause lots of various, and potentially more severe, issues. Therefore, I was a great candidate for doing a repair since I didn’t have any complicating factors.
I met with a surgeon who specializes in doing robotic surgery for the procedure. This is a method where a multi-armed device is used to perform the surgery and allows the surgeon to use much finer controls to do their work with much higher precision. This also means that the surgeon only needs to make a few small incisions in the body, making this minimally-invasive process. The plan was to do the procedure and then spend one night in the hospital and be discharged the next day.
I arrived early on a Monday morning, with my son being gracious enough to drive me in and stay with me despite his dislike of hospitals. I got situated with my special gown, had multiple conversations with the surgeon, nurses, and anesthesiologists, and by 7am I was being wheeled back to the operating room.
This was the first time in my life I’ve been fully sedated. That means that once I was unconscious a breathing tube would be inserted down my throat to keep me breathing normally while the anesthesia did it’s job keeping my body fully under. I had only ever had simple sedations for things like tooth extractions, so this was a completely new experience for me. With my anxiety kicking in the nurses very kindly and gave me a little something in my IV to help relax as we headed to the OR. My final memories before losing conciousness were being wheeled into the operating room, asking about the robot (someone pointed to a big device in the corner) and then laying down on a special surgical table. The next thing I knew I was waking up in a recovery room less than two hours later.
I was told that the surgery was uneventful and that everything went just as planned. I had five small incision spots on my abdomen where the robot arms were inserted into my belly, and the biggest complaint for the rest of the day was the sore throat from the breathing tube. Thankfully, my voice was mostly back to normal before I left the hospital.
I would be sending the night in the hospital’s “extended stay” section of the surgery unit. This is a small unit for people who don’t need the care of a full hospital ward, but need to spend the night in the hospital before being discharged. My room was very basic and simple, and I had to walk into the hallway for a bathroom. But, it was also incredibly quiet and peaceful since there were only a handful of people in nearby rooms.
Once I was settled in my room the nurse got me my bag with my belongings and I started figuring out what to do with my time. Thankfully, my pain was minimal and throughout the entire recovery I never needed anything more than Tylenol. I was able to stand up and walk around with my IV pole, which was good since the bathroom was across the hall. I was getting pumped with fluids through the IV and was also restricted to a clear liquid diet. Because of this, I was peeing almost every 30 minutes for most of the rest of the day.
One other side effect of the full sedation that I was warned about was the sudden sleepies. For the next 8 hours after surgery I would feel awake and fine, watching videos on my tablet, and then suddenly, BAM… it was nap time. Although I was concerned that it would mess up my normal sleep schedule to nap so often, I was assured that it wouldn’t, and that it was just a side effect of the sedation. By evening time it had worn off and I was able to stay awake and hang out with my wife when she came to visit, as well as my friend Mike when he stopped by, and sure enough by 10pm or so I was ready for bed.
Obviously a hospital room isn’t the most conducive to sleep, but I did manage 5 hours or so of rest throughout the night. I got woken up for vitals a couple times, but mostly I was just left to rest. My only issue with the entire night was that I wasn’t given as much freedom as I would have liked around my pain control. Around 4-5am I was feeling the previous night’s dose of Tylenol wearing off and so I asked for my morning dose. However, their system apparently only lets them give it to me at 3 set times per day, not on demand. Though, I was more than welcome to a dose of Oxycodone.
This frustrated me to no end. I didn’t need a powerful narcotic (I’ve never done well on them nausea-wise), I just needed my morning dose of Tylenol. Yet, I had to wait for a day-shift nurse who apparently had more authority, to override whatever directives were in the system so that I could get the non-narcotic meds I wanted. To top it off, they sent me home with a bottle of Oxycodone despite telling them repeatedly that I didn’t need narcotics. Now, I’ve got a bottle of meds I need to dispose of safely (not hard to do just annoying). Of the entire experience, this was the most annoying aspect.
Before leaving the hospital I had to do one final swallow test down in the radiology department. This is a simple scan where you drink some fluid and they follow it through your system to make sure that there were no leaks from the procedure. I passed the test with flying colors (kudos to my surgeon) and was free to move on to a soft food diet and be discharged. I ordered up some scrambled eggs and got ready for my friend Michael to pick me up and bring me home.
Today is three weeks since the procedure and I’m almost done with the soft-foods diet. I was able to stop taking Tylenol within 5 days of the procedure, and was cleared for light activity such as walking, almost right away. By the weekend I was able to do some short and flat 3 mile walks at the park, and early the following week I was on my bike for some 2-3 mile pedals to the coffee shop.
The biggest surprise for me in the recovery process was how worn out I felt for the first week and a half. Despite being minimally-invasive, and only having some small scars, there was a lot of work done inside my belly. All of that work takes time to heal, and that healing process takes energy. Thankfully, almost 3 weeks out now, I feel like my energy level is almost back to normal.
I’m sure another factor in my low energy levels was also due to the restrictive diet I was on. I could only eat soft and mushy foods, and had to do lots of small meals. My stomach just couldn’t handle large portions, and that meant trying to eat a little bit, many times, throughout the day. I’ve lost 8-10lbs through the process, which isn’t a bad thing, but it wasn’t from eating healthy foods. It was from simply not getting enough calories each day compared to what I was used to.
The first few days of recovery were also tough mentally. Having discomfort and low energy meant that I was pretty much stuck at home and couldn’t get out and do the things I wanted to do on beautiful summer days. My wife had to deal with a very grumpy guy throughout the first week. She was very supportive and understanding and did what she could help me get through it all, even if that meant just leaving me alone to stew and grumble to myself.
Earlier last week I had my post-op check in and everything has been going fine. The scars are healing, my appetite is coming back, and starting now I can incorporate more foods into my diet. I only had one “bad swallow” during my recovery when I ate too big of a piece of a banana and didn’t chew it fully. For 20-30 seconds I was in excruciating pain as the lump passed through the repaired surgical area. I only had to do that once to learn my lesson about being careful when eating until that fully heals. My post-op doc said that as long as I was able to eat fine after that (which I was) it was no big deal, and just a warning about how tender my insides will be for a couple more weeks.
I’ve also been able to get some solid biking in, commuting to work both directions the other day (20 miles total). There were also some short 30-60 second running intervals in my weekend long walk to start to build that recovery back as well. I was told that as long as I’m not feeling any pain, I’m cleared to build back slowly as I feel able. Based on how I’m feeling now, I should be back to regular running within the next 3 weeks or so.
So that’s my story of my first surgery experience, and my experience with a repair of a hiatal hernia. I haven’t had to take any GERD medications since I had the surgery, and so far my symptoms seem to be gone. I still have had some minor throat clearing going on, but hopefully that will disappear in the future as well. I’m glad I got this taken care of when I did, despite wishing it wasn’t the peak of summer. However, it’s ending up to be just fine and I’m guessing I’ll be back to normal before I know it.
For those that are finding this blog because they’re considering this surgery, I hope you found some of this information informative. The robotic procedure was great and from what I’ve been told, the recovery is MUCH easier than an open incision procedure. I’m thankful my condition made me a candidate for it, and hopefully I won’t need to go through anything like this again for a good long time. Now it’s time to get back to recovery and enjoying the rest of our beautiful summers here in the upper midwest.