If you have a Hiatal Hernia watch this brief video.
What is a Hiatal Hernia?
The diaphragm is a broad, flat muscle that separates the chest cavity from the abdominal cavity. It moves up and down when you breathe, creating negative pressure in the chest cavity. The esophagus passes through a small opening in the diaphragm called the hiatus. If this opening becomes stretched, some or all of the stomach is pulled up into the chest cavity. This condition is called a hiatal hernia. While the majority of hiatal hernias are relatively small, with only the upper part of the stomach sliding up through the diaphragm, they often become larger over time. If the hernia becomes large enough, the entire stomach and even other abdominal organs can become permanently displaced above the diaphragm.
Symptoms of Hiatal Hernia
The most common symptoms of hiatal hernia include:
- frequent belching
- chest pain
Most patients who have been diagnosed with a hiatal hernias experience one or more symptoms on a regular basis. They may also be under the impression that they have no choice but to live with their symptoms. However, defects in the diaphragm can and often should be surgically repaired as a means of controlling the symptoms. Huge defects in the diaphragm can result in a twisting or obstruction of the stomach with symptoms ranging from nausea and persistent vomiting of undigested food to weight loss and malnutrition. Ulcerations can also occur within the herniated portion of the stomach and are a common source of upper GI bleeding and chronic anemia. (Watch Dr. Sewell provide a video explanation)
Testing for Hiatal Hernia
Large hernias can sometimes be seen on a standard chest x-ray, but most hiatal hernias are only identified by either an Upper GI x-ray or at the time of endoscopy. One or both of these diagnostic procedures should be performed when hiatal hernia is suspected. If the diagnosis is confirmed, initial treatment may include acid suppressing medicines to control heartburn, along with lifestyle changes to reduce symptoms of GERD. However, once a hiatal hernia occurs it will never resolve on its own. Since the pressure in the abdominal cavity is greater than the pressure in the chest cavity, the hernia will only get larger over time as more and more of the stomach is pushed up through the defect.
Minimally Invasive Treatment Options
Laparoscopic surgery can offer patients with a hiatal hernia a minimally invasive repair that typically only requires an overnight stay in the hospital. Even very large hernias can usually be repaired in this way by an experienced laparoscopic surgeon. (Watch video of Laparoscopic Hiatal Hernia Repair) In rare cases the stomach may not be able to be completely mobilized out of the chest cavity due to a shortened esophagus. In these rare situations an esophageal lengthening procedure, called a Collis Gastrostomy may need to be performed before the hernia can be repaired.
As a final part of virtually any hiatal hernia repair, the top part of the stomach is wrapped around the lower esophagus creating what is called a fundoplication. This helps prevent problems with gastric reflux after surgery and further reduces the chances of the hernia coming back. Your diet will be restricted for a few weeks following surgery to allow time for the swelling to resolve. Click HERE to view the post-operative diet instructions.
Recurrent Hiatal Hernia Repair
Occasionally, despite what was an effective repair the hiatal hernia can come back. This may be due to excessive retching or vomiting, heavy lifting or straining or in some cases for no apparent reason. The symptoms of a recurrent hiatal hernia include chest pain, typically through into the back, indigestion or heartburn, and occasionally even trouble swallowing. Having a recurrence of the hernia is obviously disappointing, but the good news is it can generally be repaired again using the same minimally invasive procedure. A recurrence is more likely if the initial hernia was very large and this is also the case with subsequent repairs. The routine use of some type of mesh material to strengthen the diaphragm closure is generally recommended to reduce the chances of the hernia coming back.
Dr Sewell has extensive experience in the laparoscopic repair of recurrent hiatal hernias. If you have been told that the reoperation can only be done with an open surgery technique, he would be happy to provide you with a second opinion before you have anything done.