Those who walk the halls of Womack Army Medical Center to get a prescription refilled, lab work done or frequent the dining facility probably do not have access to the operating room.
It is a place where the leaders of Army Medicine and professionals in the healthcare field would link the term high reliability organization.
In here, there is no room for mistakes.
For the surgery they’re about to perform, the roles of Dr. Vito Ciriglianlo, WAMC gastroenterologist chief, and Dr. Viet Nguyen, WAMC gastroenterologist and division of medicine chief, are to perform a hernia repair in conjunction with a fundoplication.
“A fundoplication is when you are tightening up the top of the stomach or the bottom of the esophagus in order to prevent reflux,” said Cirigliano. “It is an anti-reflux procedure.”
A hiatal hernia pulls up part of the stomach into the chest cavity, leading to people experiencing severe acid reflux. According to Nguyen, the goal of the surgical team is to bring the stomach back down into the abdomen and keep it there, preventing any further severe acid reflux, improving that person’s quality of life.
WAMC is the only hospital in North Carolina and the only medical center in the Department of Defense currently performing the fundoplication procedure, according Cirigliano.
Dr. Katherine Hetz, WAMC robotics surgeon, and lead surgeon for this particular procedure, is an integral part of the process.
“The process to repair a patient’s hiatal hernia involves freeing up the esophagus and any attachments it may have in the chest cavity, ensuring the muscle between the esophagus and the stomach remains in the abdomen, tightening the diaphragm to prevent this muscle from moving up to the chest and using the stomach to tighten the muscle between the esophagus and the stomach,” said Hetz.
This type of elective surgery is something that the patient can request, but is often the last resort to improve their quality of life.
According to Nguyen, the procedure is for patients having severe heartburn symptoms who haven’t responded to multiple medications. He adds that a person’s anatomy can even be a factor in diagnosed acid reflux.
“We also perform this procedure for our Soldiers that don’t want the side effects of the medications and they don’t have to go to the field and carry medications with them while trying to focus on their mission,” he said.
Some side effects of taking acid reflux medication includes: increased infection, dementia and association with osteoporosis.
This non-invasive procedure is performed with a few simple tools — a scope, a camera, a light and very skilled doctors. The endoscope is inserted through the mouth with a device that fires sutures to recreate a barrier keeping the acid in the stomach and away from the esophagus.
“People don’t want to be on medication long term and if we can get them off of those medications, the fewer the meds the better,” Cirigliano said.
For more information on hiatal hernia repairs, visit the Journal of Robotic Surgery website at www.ncbi.nlm.nih.gov/pmc/articles/PMC4766202.

(Editor’s Note: This is a series article that will focus on three aspects of having a transoral incisionless fundoplication, a hiatal hernia repair via robotic surgery, and the patient perspective on experiencing severe acid reflux.)