Hiatal Hernia

Hiatal hernia is a condition in which part of the stomach pushes upward through an opening in the diaphragm into the chest cavity. The diaphragm is the sheet of muscle used in breathing which separates the chest from the abdomen. A small opening, called the hiatus, normally exists in the diaphragm. It is through this opening that the esophagus connects to the stomach. If the stomach pushes upward through this opening due to a weakness in the diaphragm, however, this results in a hiatal hernia.

Hernias may cause reflux, or back flow, of acid from the stomach into the esophagus, resulting in various degrees of discomfort or distress. This back flow of acid is called gastroesophageal reflux disease, commonly known as GERD. Surgical repair is necessary if nonsurgical treatments are ineffective or symptoms exacerbate. A hiatal hernia, like any hernia, can become serious is it becomes incarcerated (trapped) or strangulated, where blood flow is cut off and tissue dies. In either of these cases, emergency surgery is necessary.

Causes of a Hiatal Hernia

While some hiatal hernias are congenital, causing gastroesophageal reflux in infants, hiatal hernias are most common in people 50 years of age and older. A hiatal hernia may be due to a weakening of the supportive tissue at the juncture of the esophagus and stomach. Risk factors that increase the chances of hiatal hernia development are as follows:

• Increasing age
• Obesity
• Smoking
• Injury to the area
• Unusually large hiatus from birth
• Hard or persistent coughing or sneezing,vomiting or straining

Symptoms of a Hiatal Hernia

In most cases, a small hiatal hernia doesn't cause problems and may only be accidentally discovered upon physical examination. A large hiatal hernia, however, can allow food and acid to back up into the esophagus, leading to various problems. The patient may experience any or all of the following:

• Heartburn
• Belching
• Nausea
• Regurgitation
• Chest pain
• Difficulty swallowing
• Shortness of breath

Diagnosis of a Hiatal Hernia

Once a hiatal hernia is suspected, the physician will do one or more tests to confirm the diagnosis. The diagnostic tests which may be performed are usually one or more of the following:

Barium X-ray - A test in which the patient drinks a thick liquid containing barium in order to coat the area. Once coated by this solution, clear silhouettes of the organs and tissues involved may be viewed on X-ray.

Endoscopy - Endoscopy is a diagnostic viewing through a thin tube with a camera inserted through the mouth into the upper intestinal tract. An endoscopy is performed with sedation.

Manometry - A diagnostic test in which the pressure of muscle contractions in the esophagus are measured.

Treatment of a Hiatal Hernia

Heartburn medications are typically used to treat the symptoms of a hiatal hernia. If the symptoms persist, then surgery is necessary to repair the hiatal hernia. Surgery may also be done in emergency situations, including if the stomach gets stuck in the diaphragm.

Regardless of the approach used, hiatal hernia repair surgery takes about two hours and is performed under general anesthesia. If performed laparoscopically, the surgeon will create a few small incisions on the abdomen, through which a camera and other surgical instruments are inserted; the abdomen is then displayed on a screen for the duration of the procedure. Patients undergoing laparoscopic hiatal hernia repair face a shorter recovery time compared to other approaches. If open surgery is used, a large incision is made on the abdomen, through which the hernia will be repaired. Either approach involves returning the stomach to the abdomen and shortening the hiatus to prevent recurrence. Stitches are then used to close the incision(s), and the patient is taken to a recovery room.

Depending on the approach used, a hospital stay of 2 to 6 days may be required following hiatal hernia repair surgery. Full recovery takes up to 3 months; during this time you may experience bloating after meals or difficulty swallowing, but these usually pass. To minimize discomfort during the recovery period, be sure to follow your surgeon's directions regarding diet and physical activity.

As with all surgical procedures, there is a slight risk of complications from the general anesthesia. Other risks include bleeding and infection, but these rarely occur. Your surgeon will discuss all the risks and benefits of hiatal hernia repair surgery with you beforehand, allowing you to make an educated decision.

To learn more about our Hiatal Hernia Services, please contact us at (516) 627-5262 today to schedule an appointment.