A hiatal hernia is when part of the stomach bulges through the hiatus into the chest cavity. This can cause GERD symptoms like heartburn. Surgery may be needed if the hernia is large.
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Hiatal Hernia Basics
A hiatal hernia is when part of your stomach bulges up through your diaphragm and into your chest. The diaphragm is the muscle that separates your chest from your abdomen. Usually, a hiatal hernia doesn’t cause any problems and you won’t even know you have one. Occasionally, it can cause heartburn or other symptoms.
What is a hiatal hernia?
A hiatal hernia is a condition that affects the stomach and esophagus. The stomach is a muscular sac that stores food andDigestive juices. The esophagus is the tube that carries food from the mouth to the stomach.
A hiatal hernia occurs when part of the stomach bulges through an opening in the diaphragm. The diaphragm is a muscle that separates the chest from the abdomen. This opening is called the hiatus.
Normally, the hiatus is only large enough for the esophagus to pass through. But if part of the stomach bulges through, it can cause symptoms such as heartburn and chest pain. A hiatal hernia can also make it difficult to swallow or belch.
Hiatal hernias are common, and most people with them don’t have any symptoms. But some people do have symptoms, and for some, they can be severe.
What causes a hiatal hernia?
Most commonly, a hiatal hernia occurs when the upper part of the stomach protrudes through an opening in the diaphragm — the muscle that separates your chest from your abdomen. This opening is called the hiatus.
Your diaphragm is normally open only large enough to allow a small tube (the esophagus) to pass through. When a hiatal hernia occurs, a portion of the stomach bulges up through this opening and into your chest.
A hiatal hernia may develop for no apparent reason. In other cases, it may be related to:
-Coughing
-Lifting heavy objects
-Pregnancy
-Severe vomiting
-Straining during a bowel movement
What are the symptoms of a hiatal hernia?
The most common symptom of a hiatal hernia is heartburn. Other symptoms may include:
-Chest pain
-Breathing difficulty
– belching
– Vomiting
– Swallowing difficulty
When is surgery necessary?
Hiatal hernias are most often seen in people over 50 years of age. However, surgery is only necessary if the hernia is causing symptoms. The most common symptom of a hiatal hernia is GERD.
When is surgery the best option?
The choice to have surgery for a hiatal hernia is usually made when other treatments haven’t worked and the person continues to have symptoms, such as GERD, or when the hiatal hernia is very large. Some people with a very large hiatal hernia may also have trouble swallowings or even choking.
When is surgery not the best option?
There are a few situations where surgery is not the best option for treating a hiatal hernia. If the hernia is very small, asymptomatic (not causing any symptoms), and not likely to get larger, your doctor may recommend watchful waiting. This means monitoring the hernia to see if it changes over time or causes any problems.
How is surgery performed?
Surgery for a hiatal hernia is generally performed as an outpatient procedure, meaning you won’t have to stay in the hospital overnight. The surgeon will make an incision in your chest and abdomen and then push the hernia back into your stomach. In some cases, the surgeon may need to wrap the top of your stomach around the lower part of your esophagus to create a new opening for the esophagus. This is called a fundoplication.
What are the different types of surgery?
There are four main types of surgery used to treat a hiatal hernia:
1. Nissen fundoplication. This is the most common type of surgery. The surgeon wraps the top of your stomach around the lower part of your esophagus. This strengthens the connection between them.
2. Dor fundoplication. With this type of surgery, the surgeon wraps part of your stomach around the lower part of your esophagus and sews it in place.
3. Toupet fundoplication. With this type of surgery, the surgeon creates a small pouch at the top of your stomach and sews it shut. The pouch is then wrapped around the lower part of your esophagus.
4. Hilal abdominal repair. This is a newer type of surgery that is done through a minimally invasive approach (laparoscopic). The surgeon makes several small incisions in your abdomen and inserts special instruments through these incisions. The surgeon then staples or sews the hernia sac shut and wraps part of your stomach around the lower part of your esophagus to reinforce the connection between them.
What are the risks of surgery?
Surgery for a hiatal hernia may be performed as an open procedure or as laparoscopic surgery.
Open surgery is the more traditional approach. The surgeon makes a single, large incision in your abdomen and moves your organs around to access your stomach. Once the repair is complete, the surgeon closes the incision with stitches or staples.
Laparoscopic surgery is a less invasive option. The surgeon makes several small incisions in your abdomen and inserts special instruments through these openings. One of these instruments has a tiny video camera on the end, which allows the surgeon to see inside your abdomen while operating.
The risks of any surgical procedure include bleeding, infection, and adverse reaction to anesthesia. Risks specific to hiatal hernia surgery include:
– Damage to nearby blood vessels or organs, such as your lungs or esophagus
– Difficulty swallowing or speaking after surgery
– Persistent pain after surgery
What is the recovery like?
Hiatal hernia surgery is a procedure to repair a large hiatal hernia. This type of hernia occurs when the stomach bulges up through the diaphragm into the chest. The diaphragm is a muscle that separates the chest from the stomach.
What can you expect after surgery?
After surgery, you can expect to stay in the hospital for 3-5 days. You will likely have a tube (or drains) in your chest to help remove any excess fluid. You will also have a tube in your nose (or nasal cannula) to help you breathe. You will be given pain medication to keep you comfortable. It is important to walk as soon as possible after surgery to help prevent pneumonia.
What are the risks of not having surgery?
If you have a hiatal hernia, you may not need surgery. If your symptoms are not severe and you do not have other health problems, your doctor may just tell you to:
– avoid foods that make your symptoms worse
– eat smaller meals more often
– eat slowly and avoid eating before lying down
– lose weight if you are overweight
Your doctor also may prescribe medications to treat GERD, such as:
– antacids to neutralize stomach acid
– histamine blockers to reduce stomach acid production
#Proton pump inhibitors (PPIs) to block stomach acid production
