By the term hiatus hernia we mean the projection of the stomach into the chest. The thorax is separated from the abdomen by a muscular formation called the diaphragm. Normally in the center of the diaphragm there is a hole through which the esophagus enters and connects with the stomach. In the case of hiatus hernia, the stomach is pushed up and enters the chest through this hole.
Generally there are two main types of hiatus hernia:
The “sliding hiatus hernia” in which the lower part of the esophagus and the upper part of the stomach “slip” up and into the chest.
Para esophageal hernia in which the esophagus and upper part of the stomach remain in place but some other part of the stomach enters through a hole in the diaphragm in the chest and sits next to the esophagus. It is considered a more dangerous form of hiatus hernia as it has more chances of strangulation of the stomach.
CAUSES OF HIATUS HERNIA
The causes of hiatus hernia are not fully known. It generally occurs when there is weakness of the diaphragm muscle tissue. The following seem to contribute to this weakness:
Age over 50
Injury to the specific area
Intense weight lifting
In many cases, a hiatus hernia is asymptomatic. As its size increases, so do the symptoms, which include:
“heartburn” and burning in the chest and sternum
Chest and stomach pain
Bad taste in the mouth
Diagnosing hiatus hernia requires a good history from an experienced General Surgeon. The diagnosis is confirmed with the following tests:
Chest x-ray with barium swallow: The patient drinks a special material and then takes a chest x-ray in a specific position which shows the stomach sliding into the chest.
Gastroscopy: The gastroenterologist inserts a tube with a camera through the throat into the esophagus and stomach.
Esophageal manometry: A special type of catheter is inserted into the esophagus and measures the pressure in the esophagus when we swallow.
In many cases patients have little to no symptoms and do not need treatment at all. In case of symptoms, we initially apply conservative treatment which includes medication WITH drugs that reduce the production of the acidic stomach fluid. Most of the time medication has very good results. At the same time, the patient can apply the following:
Many small meals instead of a few larger ones
Avoiding fried foods, alcohol, chocolate, spices and caffeine
Do not lie down immediately after eating
Weight reduction in case of obesity
In case of failure of the conservative treatment, then we proceed with the surgical repair of the hiatus hernia. Nowadays, the operation of choice is laparoscopic reconstruction. Through 4-5 small holes with a diameter of 0.5-1 cm we pull the stomach back into place and fix the hole in the diaphragm with simple sutures or in the case of a large hiatus hernia a special mesh may be used to close the hole. At the end, we also perform a stomach fold, usually according to Nissen. With this technique we wrap part of the stomach around the esophagus giving a permanent solution to the problems created by gastroesophageal reflux. Surgical treatment has a success rate of 90-95% according to the international literature. The laparoscopic operation is bloodless and painless, and the patient leaves the clinic the next day.
ADVANTAGES OF LAPAROSCOPIC TREATMENT
Significantly less postoperative pain
Faster recovery and immediate return to work and daily activities
Better cosmetic result as large incisions are avoided
Lower recurrence rates compared to the open method according to international literature
What doctor should I visit if I suspect I have a hiatus hernia?
For the diagnosis of the disease, the specialty of the General Surgeon or the Gastroenterologist is appropriate. For the surgical treatment of the disease, the choice of the General Surgeon is the only way.
I have been diagnosed with a hiatus hernia. Should I have surgery?
In the majority of cases, surgery is not needed. If our symptoms are mild or controlled with medication then surgery is not needed. However, in the event that we have severe symptoms despite medical treatment, then the hiatus hernia must be repaired surgically.
I have a hiatus hernia. Is it better to have open or laparoscopic surgery?
Here the answer is clear. Laparoscopic repair has significant advantages. In today’s era, laparoscopic reconstruction is a one-way street.
How long do I have to be off work if I have surgery?
A week off from work is usually recommended
How much does hiatus hernia surgery cost?
The cost depends on the type of patient insurance as well as whether any type of mesh will be used
How long does it take to book a hernia surgery?
The booking is immediate and the operation can be done even the day after the clinical examination.
If I have surgery, is there a chance of recurrence and return of the symptoms?
The success rate of laparoscopic surgery reaches 90-95%.