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Nick asked...

Last year I had a Nissan Fundoplication.

Last year I had a Nissan Fundoplication as I was having problem with G.O.R.D and it was diagnosed as being linked to a 4-5cm Hiatal hernia, one year on the wrap has migrated and following on from a gastroscopy a 1-2cm Hiatal hernia has been found but my consultant seems hesitant to treat this even though I am having further symptoms, I am concerned that this is because the consultant does not wish to appear to have made an error, which is not how I would consider it in any case. Also during the gastroscopy they found a 4mm polyp which they have sent for histology, what is the likelihood of this being benign/malignant, and would this be affected by the length of time that I had stomach acid pooling at the bottom of my osoephagus?

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The answer

At the bottom of the oesophagus, or gullet, is a valve between the gullet and the stomach. The stomach contents are extremely acidic – even the stomach lining, which is designed to cope with this level of acidity, can sometimes get inflamed. If you have a hiatus hernia, part of the stomach pushes up into the lower chest through the diaphragm. This allows acid from the stomach to reflux into the oesophagus, causing pain and inflammation. Surgery − usually fundoplication – isn’t done as often as it used to be because we now have much more effective medications to suppress stomach acid.

In this operation, the ‘fundus’ (upper curve) of the stomach is wrapped around the oesophagus and stitched into place to strengthen the valve between the two. Fundoplication, like all operations, does carry risks and isn’t always successful. Although it improves symptoms in about 4 out of 5 people who have it, almost half will get recurrence of their symptoms sooner or later. The fact that the wrap has slipped is a well-recognised complication and doesn’t necessarily mean anything was done incorrectly at the time. Your surgeon may be cautious about doing more surgery because second procedures are less likely to succeed and carry more risks.

The majority of stomach polyps are not malignant. Most polyps are found in the stomach rather than the oesophagus, and therefore having a hiatus hernia shouldn’t increase your risk.

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