Hiatal Hernia Treatment
Question
My child was diagnosed with a hiatal hernia. The doctor is recommending a Nissen Fundoplication. Is this the standard treatment?
Answer of our experts
A hiatal hernia means that part of the stomach is in the chest. This leads to more severe GER because the muscle at the top of the stomach can't work with the pinching off effect of the diaphragm pushing in on the esophagus. The amount of hiatal hernia may alter as we growmuch like the legs and feet don't always have growth spurts at the same time. However, if there is a large hiatal hernia, the GERD can be very difficult to control medically and a Nissen may be required
CP/TK 7-13-10
Approved byClinical Advisory Board (CAB)
Answer is checked and valid for
Recommendation(s)
Reflux
R32
Consider always gastro-oesophageal reflux disease (GORD) in any individual with CdLS owing to its frequency and wide variability in presentation, which includes challenging behaviour.
R33
Modification of nutrition and proton pump inhibitors (PPI) are the first-line treatments of GORD. Anti-reflux medications need to be used to their maximum dosage. Surgical interventions for GORD should be limited to those individuals with CdLS in whom nutritional and medical treatments have been unsuccessful or airway safety is at risk.
R34
If GORD symptoms persist, endoscopy should be strongly considered whilst an individual with CdLS is still in paediatric care.
R35
Surveillance for Barrett’s Oesophagus needs to be discussed with and decided together with the family, balancing the potential gain in health and burden for the individual with CdLS.
