Hiatal Hernia

A hiatal hernia is a condition in which part of the stomach pushes up into the chest cavity through an opening in the diaphragm called the hiatus. The hiatus is the place where the stomach and esophagus connect. When the stomach pushes through this opening due to a weakness in the diaphragm, a hiatal hernia results.

Hiatal hernias may cause reflux, or back flow, of acid from the stomach into the esophagus, resulting in varying degrees of discomfort or distress. This back flow of acid is called gastroesophageal reflux disease, commonly known as GERD. Surgical repair is necessary if nonsurgical treatments are ineffective or symptoms exacerbate. A hiatal hernia, like any hernia, can become serious if it becomes incarcerated (trapped) or strangulated, where blood flow is cut off and tissue dies. In either of these cases, emergency surgery is necessary.

Causes of a Hiatal Hernia

While some hiatal hernias are congenital, causing gastroesophageal reflux in infants, hiatal hernias are most common in people 50 years of age and older. A hiatal hernia may result from age-related weakening of the supportive tissue at the juncture of the esophagus and stomach. Risk factors that increase the chances of hiatal hernia development are:

  • Increasing age
  • Obesity
  • Smoking
  • Injury to the area
  • Unusually large hiatus from birth
  • Hard or persistent coughing or sneezing,vomiting or straining

Symptoms of a Hiatal Hernia

In most cases, a small hiatal hernia doesn't cause problems and may only be accidentally discovered upon physical examination. A large hiatal hernia, however, can allow food and acid to back up into the esophagus, leading to various problems. The patient may experience any or all of the following:

  • Heartburn
  • Belching
  • Nausea
  • Regurgitation
  • Chest pain
  • Difficulty swallowing
  • Shortness of breath

Diagnosis of a Hiatal Hernia

Once a hiatal hernia is suspected, the physician will do one or more tests to confirm the diagnosis. The diagnostic tests which may be performed are usually one or more of the following:

  • Barium X-ray
  • Endoscopy
  • Manometry

Nonsurgical Treatment of a Hiatal Hernia

Once a hiatal hernia is diagnosed, there are several possible treatments available which do not involve surgery. Assuming the symptoms acid reflux are not too severe, the physician may advise or prescribe:

  • Smaller meals
  • Head elevation after eating
  • Antacids
  • H-2 receptor blockers
  • Proton pump inhibitors

H-2 receptor blockers and proton pump inhibitors reduce the production of gastric acid.

The Hiatal Hernia Repair Procedure

In the event that medications do not provide sufficient relief for the patient to proceed living a normal life, or if the hiatal hernia is unusually large, a surgical hiatal hernia repair may be necessary. During hiatal hernia surgery, the surgeon pulls the stomach back down into the abdominal cavity and wraps the top of the stomach around the end of the esophagus. The repair is then stapled in place to avoid reoccurrence of the problem. This procedure is called a Nissen Fundoplication.

Sometime, depending on the size of the hiatal hernia, surgical mesh may be used in the repair. Hiatal hernia repairs are usually performed laparoscopically on an outpatient basis. Although the patient is usually under general anesthesia, this minimally invasive procedure results in less bleeding, scarring and pain than open surgery as well as a shorter recovery time.

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