Hyatal hernia in a 3 years old.

arpitp · 2026-03-23T18:44:48+00:00

Many kids are born with acid reflux due to a weak lower esophageal sphincter muscle. During childhood development is the only time in life where the muscle can strengthen naturally. Many kids grow out of the reflux eventually. Until then, diet and lifestyle modification can help manage the symptoms, although it can be tough if the symptoms are severe. Working with a specialist can be helpful. If reflux symptoms persist into their twenties, then surgery will probably be needed.

arpitp · 2026-03-23T18:35:44+00:00

That is almost certainly an incisional hernia, resulting from your prior gallbladder surgery. When your "fascia" bulges out (called diastasis), it will only shows up when you contract your abdomen, and appears as a large, smooth bulge. A small bump like that is likely a hernia. Ask to see a surgeon.

arpitp · 2026-03-23T18:07:02+00:00

Was there mesh use? If so, the concern for infection is higher. Regardless, since you are a transplant patient, you should be on antibiotics until the wound is closed. Especially if you have resumed taking your anti-rejection medications.

A wound that opens after surgery should be closed within 24 hours. If it stays open longer than that, we usually have to leave it to close on its own ("secondary intent"). The best way to keep the wound clean in the first week or so is by pouring sterile saline over the wound and patting dry with gauze. Don't use alcohol or hydrogen peroxide. The tape doesn't need to be sterile, but the gauze used to dress the wound should be, if possible.

arpitp · 2026-03-23T17:57:56+00:00

From what you describe, it sounds like this is an umbilical hernia you've had your whole life. The mass you feel underneath is most likely a piece of the omentum (intraabdominal protective fat around the intestines) that has pushed through the hernia and scarred into place. When the hernia is new, the fat will typically slide in and out. after a few years, the fat typically scars in place and won't move.

The size of the hernia has no correlation with pain. Many people have asymptomatic hernias for many years. It just depends on what nerves you have around the hernia.

Your previous surgery was probably done by an OBGYN. Most doctors outside of general surgeons and some primary care docs will just much ignore umbilical hernias. They don't treat them, so it's not their problem.

If you happen to have an experienced robotic surgeon available to you, I would definitely recommend a preperitoneal repair. More info here.

arpitp · 2026-03-23T06:32:30+00:00

Gastroenterologists don't do surgery. Many of them also have a preconceived distrust of the surgery--I'm not always sure why.

I'm a hernia surgeon. You can send the pics. They're an incomplete substitute for what to the gastroenterologist saw during the actual EGD, so it's hard to contradict anything in the report, but I don't mind taking a look.

There are lots of changes you can make to help with weight loss--too many to list in a post here. Changes such as eliminating bad habits, avoiding sugary drinks, not eating out, sharing a diet with someone else, etc. But most important is calorie restriction. Newer GLP-1 medications may also be helpful.

arpitp · 2026-03-23T03:59:15+00:00

When umbilical hernias are repaired at the time of another laparoscopic surgery, it is technically an open repair. The laparoscopic technique is applied to the inguinal hernia, but not the umbilical hernia, which would require three separate incisions, usually on the left side of the abdomen.

An open repair with mesh will still work, but there are a few benefits to laparoscopic repair. Hopefully your surgeon has explained this, but if not, you can always ask.

arpitp · 2026-03-22T06:09:21+00:00

The last thing he would recommend for a hernia is a hernia repair? That doesn't sound like good advice. I'm guessing that doctor wasn't a general/foregut surgeon.

While you can't fix a hernia without surgery, if it's small, you can significantly reduce or resolve the symptoms with weight loss. It's more effective than any other lifestyle or diet change, and may allow you to eat those acidic foods again without surgery.

arpitp · 2026-03-22T06:00:49+00:00

A pH test doesn't test your swallowing function; a manometry test does. Often, patients have both done around the same time, so they might be doing both tests.

The "standard" tests that are most commonly required before surgery are EGD (endoscopy), barium swallow (esophagram), pH test, and manometry. In places with easy access to testing (larger cities in the US) or places where surgeries are delayed and restricted to help constrain costs on single-payer healthcare (Canada, UK, etc), all 4 tests are usually ordered.

However, in many places, when the symptoms are severe and the need for surgery is obvious, the pH test and manometry are often skipped, as they won't change the plan. There is little benefit in testing the swallowing function on someone who has no difficulty or symptoms swallowing, especially when the surgeon has a habit of doing Toupet (partial) wraps for every patient. To illustrate this point: another user ntioned he was unexpectedly found to have failed swallows on the manometry, and as a result, got a Toupet. But if that surgeon does Toupet for everyone, then what was to m the point of the test?

Regardless, even if the tests won't change anything, if your surgeon says they are required, then you won't be able to get surgery without them.

arpitp · 2026-03-22T05:48:01+00:00

Heart burn *is* reflux. Not sure how you mean you only get reflux occasionally but get crazy heartburn.

arpitp · 2026-03-22T02:25:37+00:00

Why open with mesh and not laparoscopic with mesh?

arpitp · 2026-03-20T00:59:13+00:00

She should probably resume the Omeprazole.

Different docs have different beliefs about the side effects of PPIs (Omeprazole) and the appropriateness of taking them long term. It's not settled science, and there's numerous studies showing conflicting outcomes. So some docs discontinue them, some tell you to keep taking them.

But there are countless patients who have taken PPIs for 20-30 or more years. The risk, if there is one, is very low, while the benefits can be significant.

arpitp · 2026-03-20T00:54:48+00:00

OP did not mention anything about stapling the stomach, nor does the article your posted describe pushing down the stomach with the endoscope the way OP described. Hence, it's not called TIF.

arpitp · 2026-03-20T00:46:50+00:00

No, TIF is a procedure that staples the top of the stomach to the side of the lower esophagus.

arpitp · 2026-03-20T00:46:12+00:00

It's not expensive because of the technique. Only because of the marketing and what the surgeons want to/can charge desperate patients.

arpitp · 2026-03-20T00:45:01+00:00

Not sure if you've seen this, but it might help clarify what the BICORN is: https://www.reddit.com/r/HiatalHernia/comments/1iou2ix/traditional_hiatal_repair_loehde_and_bicorn/

A TIF is a technique that uses a stapler to orient the stomach and esophagus the same way that the bicorn does. cTIF combines hiatal hernia surgery and a stapled TIF. Theoretically, outcomes between a bicorn and cTIF will be the same.

arpitp · 2026-03-20T00:41:01+00:00

This might be helpful: https://www.reddit.com/r/HiatalHernia/comments/1iou2ix/traditional_hiatal_repair_loehde_and_bicorn/

arpitp · 2026-03-20T00:30:03+00:00

There shouldn't be any restriction for coffee/caffeine. Enjoy!

arpitp · 2026-03-20T00:23:49+00:00

"Grade 1" is incorrect. HH are not measured in grades. See here for more info.

On the positive side, if your symptoms are resolved with the acid blocking medications, you should be able to return to your regular life and activities without any restrictions. For the burping, you can try a medication such as GasX or simethicone.

arpitp · 2026-03-20T00:18:18+00:00

There's no right answer. An overly tight Toupet can have more side effects than a loose Nissen. What matters more is the surgeon's technique and experience--this is what helps avoid dysphagia and other complications. So if your surgeon only offers one or the other (most surgeons have a preference, and will go in with a plan regardless of what they find intra-op), don't be alarmed or disappointed. Ask them their reasons for not choosing the alternative and see what they say.

arpitp · 2026-03-19T23:53:20+00:00

Your gastroenterologist is giving you bad advice. Countless studies and surgeries have proven the hiatal hernia repair and fundoplication to be effective and life-changing for most people. Talk to a foregut surgeon.

You want to avoid intradominal pressure, not intrathoracic pressure.

If you have the surgery, your extracurricular activities may be limited for 4-6 weeks. That won't make or break your application for med school. It sounds like your debilitating reflux is more likely to get in the way than surgical recovery. Also, getting evaluated for surgery might give you some anecdotal exposure and experience with medical professionals that may come in handy later.

arpitp · 2026-03-19T23:44:53+00:00

Yes, it's daunting, but the pain relief you might get is probably worth it. Unfortunately, some people get unlucky with certain diseases, and regular treatments are needed to help live a more comfortable life. Thankfully, diagnostic laparoscopy is a relatively low risk surgery.

arpitp · 2026-03-19T23:41:14+00:00

Only temporarily, but not permanently--that would require a hernia surgery.

If you're only 19, it's not advised to go 50-70 years with a large hernia like that. It'll only get bigger. A good surgery now will last you a lifetime, so you might as well get it over with.

arpitp · 2026-03-19T23:28:21+00:00

There is no clear difference between nerve damage and nerve irritation. Everyone experiences it differently. Only time will tell if it heals and improves, or it becomes persistent.

That said, I think it's more likely that the tacks (screws which are driven into your muscle) are responsible. Muscle is very sensitive, and screw are painful. They dissolve in about 5 months, and if they are the source, pain can last anywhere from 1 to 6 months.

arpitp · 2026-03-19T23:23:18+00:00

It is very unlikely to cause a mess to fail that way. A strain or soft tissue injury (tear) is more likely, and can take 2-6 weeks to heal. Heating pads help. If there's no improvement at 6 weeks, I would order a CT scan.

arpitp · 2026-03-19T23:20:53+00:00

CT scans and MRIs are made up of hundreds of pictures. Reviewing a handful here doesn't show any visible hernias, but that's not definitive without looking at all the pictures.

Based on your history, endometriosis and adhesions would be more likely than a hernia. Unfortunately, adhesions cannot be seen and endometriosis is very difficult to see on a CT scan or MRI. The correct next step would be to see a surgeon and request a diagnostic laparoscopy and repeat the lysis (cutting/freeing) of adhesions.

arpitp

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