Description

The Laparoscopic Repair of Large Hiatus Hernia Lecture by Dr. R. K. Mishra is an enlightening academic session that blends clinical knowledge, surgical expertise, and evidence-based techniques for managing one of the most challenging conditions in minimally invasive surgery. Hiatus hernia, particularly when large or complicated, presents unique anatomical and physiological issues that demand both precision and advanced laparoscopic skills. In his lecture, Dr. R. K. Mishra, a globally renowned laparoscopic and robotic surgeon and Director of World Laparoscopy Hospital, highlights every critical aspect of diagnosis and surgical repair. He emphasizes the importance of careful patient selection, preoperative evaluation, and understanding of hiatal anatomy. The session explains how large hiatus hernias may cause reflux, dysphagia, chest pain, or even respiratory distress, underscoring the necessity of surgical intervention when conservative management fails. Key Highlights of the Lecture: Anatomy and Pathophysiology Dr. Mishra begins with a detailed review of the gastroesophageal junction and diaphragm, explaining how enlargement of the esophageal hiatus allows the stomach or other abdominal contents to herniate into the chest cavity. Clinical Presentation & Diagnosis The lecture covers typical symptoms such as chronic gastroesophageal reflux, regurgitation, and postprandial discomfort. He explains diagnostic tools like endoscopy, barium swallow, and high-resolution manometry. Surgical Principles of Repair Port placement and ergonomics for optimal access. Reduction of herniated contents back into the abdominal cavity. Dissection and mobilization of the esophagus to ensure adequate intra-abdominal length. Hiatal closure (cruroplasty) using non-absorbable sutures or mesh reinforcement for large defects. Fundoplication techniques (Nissen or Toupet) to restore the anti-reflux barrier. Role of Mesh in Large Hiatus Hernia Dr. Mishra discusses when mesh reinforcement is indicated and reviews the advantages and potential complications, emphasizing evidence-based decision-making. Postoperative Care & Outcomes The lecture provides insights into patient recovery, dietary modifications, and long-term follow-up to prevent recurrence. Educational Impact Dr. Mishra’s lecture not only imparts surgical knowledge but also provides practical wisdom gained from decades of performing complex laparoscopic procedures. For surgeons in training, this session is invaluable in building confidence to manage large hiatus hernias safely and effectively. For practicing surgeons, it serves as an advanced refresher course with updates on the latest minimally invasive approaches. Conclusion The Laparoscopic Repair of Large Hiatus Hernia Lecture by Dr. R. K. Mishra exemplifies the integration of theory, surgical skill, and innovation in minimal access surgery. It underscores how laparoscopy continues to revolutionize treatment, offering patients less pain, faster recovery, and superior outcomes compared to open procedures.