A hiatal hernia is the result of the upper portion of the stomach or organs in the upper abdominal cavity pushes through a weakened area in the diaphragm into the chest. The condition is fairly common and can happen at any age. There are two primary types of hiatal hernias: paraesophageal and sliding.
- Sliding hiatal hernias
- Paraoesophageal hernias
- What Is the Main Cause of a Hiatal Hernia?
- What Symptoms Are Common With a Hiatal Hernia?
- How is a Hiatal Hernia Diagnosed?
- Treatment Plan for Hiatal Hernias
Sliding hiatal hernias
With sliding hiatal hernias, the stomach and esophagus slide into the chest cavity through the hiatus. Sliding hiatal hernias are often associated with gastroesophageal reflux disease or GERD. Currently, it’s estimated that 25 percent of adults will have developed a sliding or hiatal hernia by the time they turn 40.
Paraesophageal hernias occur less frequently but they are usually more serious. This type of hernia often goes undetected because in most cases, it doesn’t cause symptoms. When symptoms do occur, they usually include pain in the chest and upper abdomen and trouble swallowing. Paraesophageal hernias that cause symptoms require surgery for repair. Asymptomatic paraesophageal hernias typically manageable with self care and do not require surgery.
Symptomatic paraesophageal hernias can be dangerous because they are progressive. Without treatment, this type of hernia can become stuck, cutting off blood flow to the stomach or entrapped tissues. When paraesophageal hernias become incarcerated, the condition is a medical emergency.
What Is the Main Cause of a Hiatal Hernia?
There is no singular cause for hiatal hernias. However, certain conditions make the development of one more likely. Abdominal muscle weakness is associated with most hiatal hernia cases. Increased pressure and force on the connective tissues supporting the musculature wall of the abdominal cavity is the primary factor in hiatal hernias.
The muscles and supportive issues that keep the organs in place behind the abdominal cavity become weaker with age and weight. Hiatal hernias can also be caused by acid reflux, coughing, straining during bowel movements, vomiting, poor lifting mechanics, and muscle strain and injury.
Keep in mind that hiatal hernias can also develop from other conditions, such as pregnancy, congenital defects, obesity, fluid retention.
What Symptoms Are Common With a Hiatal Hernia?
Paraesophageal hernia symptoms may come and go or not occur at all. The presence of symptoms is usually a sign that there is a hiatal hernia that is becoming worse. The most common symptoms of a hiatal hernia include:
- Pain in the upper abdomen
- Pain in the chest
- Acid reflux
- Difficulty swallowing
- Shortness of breath
How is a Hiatal Hernia Diagnosed?
To properly diagnose a hiatal hernia, diagnostics are necessary. The most common tests used to detect the presence, location and severity of a hernia are endoscopy, barium swallow, gastric emptying evaluation, gastric pH, and esophageal manometric.
Endoscopy utilizes a long, thin tube with a small camera attached to view inside of the upper digestive tract for signs of damaged or weakened tissues and bulges.
A barium swallow test requires patients to drink a special fluid that enables the doctor to see abnormalities inside the esophagus and stomach via X-ray. A barium swallow test is extremely useful because it also shows the presence of ulcers, tumors and the size and formation of the hernia.
Esophageal manometry evaluates the coordination and strength of the esophagus muscle and swallowing function.
pH testing is done to determine the acidity of the environment inside the esophagus. It is also usual in helping the doctor to determine the cause of certain related symptoms like reflux.
Gastric emptying diagnostics are used to determine how long it takes the stomach to empty after meal consumption. This type of test is often ordered for patients with a suspected hiatal hernia and are experiencing nausea and vomiting.
Treatment Plan for Hiatal Hernias
Mild hiatal hernias do not usually cause symptoms, so immediate treatment is not necessary. Hernias that do cause symptoms require treatment.
Nonsurgical treatments for hiatal hernias usually include GERD management considerations. Patients are advised to watch their weight, eat healthier foods, avoid alcohol and smoking, and adopt better lifestyle habits. Tight clothing should be avoided; if symptoms become troublesome, taking over-the-counter antacids after meals is recommended.
Surgical treatments for hiatal hernias
Patients with hiatal hernias that don’t respond to medications or lifestyle adjustments need surgery to repair the condition and alleviate symptoms. Surgery is necessary to release the trapped portion of the stomach or organ from the esophagus and chest to restore blood flow. Surgery also involves repairing the defective mechanism of the esophagus to keep stomach acid and reflux from occurring.
Hiatal hernia repair surgery is also known as fundoplication and is performed as an open, laparoscopic, or robotic-assisted procedure.
Open hiatal hernia repair is major surgery and requires large incisions. It is usually reserved for patients with large or severely complicated hernias. Open hiatal hernia surgery patients have to spend several days in the hospital after their procedure before discharge home and have longer recoveries.
Laparoscopic hiatal hernia surgery utilizes small incisions, making it a minimally invasive procedure. Laparoscopic fundoplication is a permanent hernia repair solution. To perform the procedure, the surgeon uses a laparoscopy to see inside the repair site and surgical instruments to make the necessary revisions to the esophagus and sphincter tissues.
Laparoscopic and robotic-assisted hiatal hernia surgery utilize smaller incisions. Hence, patients have lower infection risks, less pain, bruising, and postoperative discomfort, quicker recovery, and better outcomes than open-surgery patients.
To find out if inguinal hernia repair surgery is right for you, Contact Orange County General Robotic Surgery at (714) 706-1257 for a consultation with Dr. Abtin H. Khosravi.