Hiatal Hernia Treatment

Overview

Hiatal hernia is a condition where the upper part of your stomach bulges through an opening in the large muscle that separates your abdomen and chest (the diaphragm). The diaphragm is a dome-shaped muscle located right below the lungs and the heart. 

Your diaphragm contracts and flattens when you inhale. This creates a vacuum that pulls air into your lungs. The diaphragm also increases abdominal pressure to help the body get rid of vomit, urine, and feces. It also puts pressure on the esophagus to prevent acid reflux (the backflow of your stomach contents). 

What Is Hiatal Hernia?

Your diaphragm has an opening called the hiatus, through which the food pipe, or esophagus, passes. A hiatal hernia occurs when your stomach pushes through this opening into your chest. It can affect individuals of any age and gender. However, it is more common in those who are 50 or older.

What Are The Types Of Hiatal Hernias?

Hiatal hernias are generally divided into two types:

• Sliding Hiatal Hernia: It is the most common type and here your stomach and the lower part of the esophagus slide up into your chest through the hiatus. 
• Paraesophageal or Fixed Hernia: This type is more dangerous when compared to a sliding hiatal hernia. Here a part of your stomach squeezes through the hiatus in the diaphragm and sits next to the esophagus. This can affect the blood supply to your stomach and can eventually lead to tissue death. This is also called a strangulated hernia.

What Are The Causes And Risk Factors Of Hiatal Hernia?

The exact cause of hiatal hernias is unknown. However, it is believed to occur due to the following:

• Age-related changes in your diaphragm.
• Having a large hiatus by birth.
• Injury to the area due to trauma or a previous surgery
• Persistent pressure on the surrounding muscles that can occur due to:
  • Persistent cough 
  • Repetitive vomiting
  • Lifting heavy weights
  • Straining during bowel movements

Risk Factors 

• Advancing age (50 or older)
• Smoking
• Obesity

What Are The Common Symptoms Of Hiatal Hernia?

Hiatal hernias that are small generally do not exhibit any signs or symptoms. Hiatal hernias that are bigger may cause symptoms that are similar to GERD (gastroesophageal reflux disease). It is a condition where your stomach contents or acids travel backward into the esophagus. The symptoms of GERD include

• Difficulty swallowing
• Heartburn (burning sensation in the upper chest)
• Sour taste in the mouth
• Stomach bloating

Though there seems to be a link between hiatal hernia and GERD, one doesn’t seem to cause the other. 

How Are Hiatal Hernias Diagnosed?

For diagnosing hiatal hernias, your healthcare provider would first record your medical history and perform a physical examination. Other methods that are used to diagnose hiatal hernias are:

• Endoscopy: Here an endoscope or a thin, large, flexible instrument with an attached camera is used to view the upper digestive system.
• Esophageal manometry: Measures the muscle coordination in the esophagus while you swallow.
• A pH test: Measures the acid levels in the esophagus
• Barium Swallow: Here you will be asked to drink liquid barium before taking an X-ray. The chalky liquid gives a clear view of the digestive tract on the X-rays. 
• Gastric emptying studies: This is basically recommended for those with nausea or vomiting. It analyses how fast the stomach is getting emptied. 

How Is Hiatus Hernia Treated?

Treatment measures for hiatus hernias include lifestyle changes, medications to treat the symptoms, and surgery.

Lifestyle Changes

• Having small portions multiple times a day
• Limiting fatty and acidic foods
• Reducing the consumption of caffeinated and alcoholic beverages
• Following an active lifestyle
• Maintaining an ideal body weight
• Avoid meals 2 to 3 hours before bedtime
• Raising the level of your head while lying down (this helps gravity act on your stomach contents)
• Quitting smoking

Medications

• Antacids: They help neutralize the stomach acids. (pantoprazole, rabeprazole, etc.)
• Proton-pump inhibitors: They act by lowering the production of stomach acids.
• H2-Blockers: These medications again work by reducing the production of stomach acids and are generally prescribed for the treatment of stomach ulcers.

Surgical Treatment Options

Cases that do not subside with lifestyle changes or medications, or individuals who have severe inflammation or narrowing of the esophagus, will require surgery. The goal of the surgery is to correct gastroesophageal reflux by improving the valve mechanism at the bottom of the esophagus. This valve controls the movement of food through the esophagus into the stomach and prevents its backflow.

During surgery, the stomach and the surrounding tissues are pulled down from the chest cavity into the abdomen. The opening in the diaphragm is made smaller, and the esophageal sphincter (the valve at the junction of the esophagus and the stomach) is reconstructed in order to prevent the stomach contents from moving backward.

This surgery is referred to as “Fundoplication”. It can be performed as either an open surgery or a laparoscopic procedure. There are three types of surgeries to repair a hiatal hernia:

1. Open Surgery: Here the surgeon makes one large incision in the abdomen. The upper part of the stomach called the fundus is wrapped around the lower part of the food pipe or the esophagus. This helps tighten the sphincter which stops the stomach acid from leaking up into the food pipe.

2. Nissen Fundoplication: Here the surgeon makes multiple small incisions in the abdomen. A laparoscope or a thin flexible tube with a light and camera is inserted through an incision to view and repair the hernia. It is also known as keyhole surgery.

3. Endoluminal Fundoplication (ELF): This procedure does not require any incisions. Here the doctor would place an endoscope through your throat into your esophagus. The surgeon then tightens the area where the esophagus joins the stomach.

Endoscopic anterior fundoplication with the Medigus Ultrasonic Surgical Endostapler (MUSE) is another procedure that is used in the treatment of hiatal hernias. Here, surgical staples are used to attach the fundus (upper part of the stomach) to the lower portion of the esophagus. 

Open Fundoplication vs Laparoscopic Surgery:

What Are The Complications Of Hiatal Hernia?

Though rare, in some cases hiatal hernias can get strangulated. Here the protruding portion of the stomach can get obstructed, and the blood flow to it is cut off. This can lead to tissue death, increasing the chances of infection. This can be a life-threatening situation and will require immediate medical attention. 

Can Hiatal Hernias Be Prevented?

• Maintain a healthy body weight
• Have small portions multiple times a day
• Avoid fatty and acidic food
• Avoid activities that can strain your abdominal muscles
• Quit smoking

What Is The Long-Term Outlook For Hiatal Hernias?

Hiatal hernias that are asymptomatic will not require any form of treatment. Severe cases will require a combination of lifestyle changes, medications, and surgery. The treatment plan will differ from person to person. After surgery, most patients no longer require long-term treatment with prescription or over-the-counter antacid medications. However, it is important that you lead a healthy lifestyle where you eat healthily and stay active in order to prevent the recurrence of the hernia.

Why Choose Medfin?

Surgery can be a daunting aspect, and feeling anxious is absolutely normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty task of finding the best hospital, the finest doctor, and the latest procedure at the lowest cost. Let us take charge while you sit back and focus on your health and recovery. Think surgery! Think Medfin!