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).
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.
Hiatal hernias are generally divided into two types:
The exact cause of hiatal hernias is unknown. However, it is believed to occur due to the following:
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
Though there seems to be a link between hiatal hernia and GERD, one doesn’t seem to cause the other.
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:
Treatment measures for hiatus hernias include lifestyle changes, medications to treat the symptoms, and surgery.
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 Surgery
Involves one larger incision
Involves multiple small incisions
Requires a hospital stay (2 to 3 days)
Requires no hospital stay
Recovery can take longer (5-6 weeks)
Shorter recovery period (2-3 weeks)
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.
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.
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Hiatal hernia symptoms at times include acid reflux, which may be confused to those that occur during a heart attack. Hence one must visit a doctor immediately to avoid misdiagnosis of the condition.
A hiatal hernia may lead to strangulated hernias that obstruct blood flow and are dangerous. Also, the symptoms appear quite similar to those seen in a GERD patient and those with heart problems and ulcers in the stomach. Hence accurate diagnosis is essential to avoid complications. One must visit a general physician or gastroenterologist in such cases.
Several factors can promote the formation of a hiatal hernia like injury or strain in the abdominal area due to chronic coughing, constipation, and other underlying conditions. People who are obese, smokers and older are more susceptible to develop hiatal hernias.
Patients with hiatal hernia may experience GERD-Gastroesophageal reflux disease.
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