Final answer:
To prevent reherniation after repairing a paraesophageal hiatal hernia, surgical reconstruction of the esophageal hiatus is performed, which may include fundoplication or mesh reinforcement to secure the stomach and strengthen the hiatus area.
Step-by-step explanation:
After the repair of a paraesophageal hiatal hernia, to prevent reherniation, the common method is not to remove either the herniated stomach or the diaphragm. Instead, the typical approach involves surgically reconstructing the esophageal hiatus and securing the stomach below the diaphragm, which may include suturing the diaphragm around the esophagus to narrow the opening and prevent the stomach from herniating again.
Additionally, the surgeon may use a method known as fundoplication, where the top part of the stomach (the fundus) is wrapped around the lower end of the esophagus and sutured in place, which serves to tighten the area and prevent acid reflux. This supports the lower esophageal sphincter to better control the passage of contents between the stomach and the esophagus.
A mesh reinforcement might also be used to strengthen the area around the hiatus to further reduce the risk of reherniation. Lifestyle modifications and avoiding activities that increase intra-abdominal pressure may also be recommended post-surgery.