It’s hard to imagine someone dying from the surgery to repair a hiatal hernia. That’s exactly what happened, though, in a wrongful death medical malpractice case that I’m handling. We’ve already filed the lawsuit, have completed the depositions, and are now preparing for mediation.
As I’ve thought through what happened to this poor lady, it brought to mind some of the risks that folks should know about before going into surgery for a hiatal hernia repair.
What is a hiatal hernia?
To understand what a hiatal hernia is, it’s a good idea to know a little bit about the basic anatomy of how we’re made.
The diaphragm is a muscular wall that has a big function in helping us breathe. It’s located between the chest and abdominal cavity. The hiatus is a hole just left of center in the diaphragm. The esophagus (the “pipe” that carries food from the mouth to the stomach) passes through the hiatus into the stomach.
The place where the esophagus connects to the stomach is called the gastro-esophageal junction and should be located below the diaphragm. If any part of the stomach or bowel squeezes up through the hiatus and is located above the diaphragm, it’s called a hiatal hernia.
Hiatal hernias are more common in women and in people who are overweight. Many people with a hiatal hernia don’t even know it because they don’t have symptoms. Often the first sign of a hiatal hernia is gastric reflux. Experts recommend evaluation by a physician when symptoms include things like severe chest or abdominal pain, nausea and vomiting, and bowel problems like being unable to have a bowel movement or pass gas.
The risks of hiatal hernia surgery
The first risk of hiatal hernia surgery is whether or not you really need it.
When I was in medical school, I remember a professor making a comment about surgeons: “If your only tool is a hammer, everything looks like a nail.” In a case I handled several years ago, an anesthesiology expert told me that virtually every bariatric or weight-loss surgical patient has a hiatal hernia.
The expert explained that surgeons routinely recommend an upper endoscopy study to identify a hiatal hernia before taking the patient to the operating room for the planned bariatric procedure. That way, the surgeon can bill the patient’s insurance company for an extra charge to fix the hiatal hernia.
This anesthesia expert felt that these upper endoscopy studies were unnecessary and basically a billing scheme. I handled a case involving the wrongful death of a patient because of anesthesia complications from an outpatient endoscopy to look for a hiatal hernia that, if present, wasn’t causing her any problems.
If your surgeon recommends an upper endoscopy or surgery for a hiatal hernia, ask about what symptoms it would treat. Make sure you understand the risks of the procedure versus the possibility of waiting.
The second significant risk that I’ve seen in my practice as a Houston, Texas medical malpractice attorney is accidental perforations that occur during the surgery. During a hiatal hernia repair, the surgeon has to physically move any part of the stomach or bowel that has crept up through the hiatus above the diaphragm. This physical movement can injure or tear the stomach or bowel.
If there’s a full-thickness tear, then the surgeon should notice and repair it before ending the surgery. If there’s a partial-thickness tear, though, then the surgeon may not be able to discover it before closing the patient back up. Partial-thickness tears often develop into full-thickness tears after surgery.
When there is a full-thickness tear or perforation of the stomach or bowel, the contents leak into the abdominal cavity. This causes an infection, which develops into sepsis if it’s not timely diagnosed and treated. Sepsis is a life-threatening inflammatory process related to a smoldering infection.
Patients who’ve had hiatal hernia repair surgery should be on the lookout for symptoms of an infection and should immediately report them to the surgeon. Sometimes surgeons don’t take these reports seriously, and this can have dire consequences for patients.
When a patient has a perforated stomach or bowel, it’s important to get it diagnosed and treated as quickly as possible. The treatment includes a return to the operating room to repair the hole, along with medical orders for aggressive fluid resuscitation and antibiotics to fight the sepsis and infection.
If you or someone you care for has been seriously injured because of delayed diagnosis and treatment of gastric or bowel perforation, then a top-rated Houston, Texas medical malpractice attorney can help you pursue your potential case.