What is a hiatal hernia?
The primary muscle of breathing, the respiratory diaphragm, separates the chest and the abdominal cavities. Everyone has small openings in their diaphragm, called hiatuses to allow structures like the aorta and the esophagus to traverse. In some people, the upper portion of the stomach, which normally resides in the abdomen, prolapses up (“herniates”) through the esophageal hiatus of the diaphragm into the chest. This is termed a hiatal hernia.
Small hiatal hernias are common and usually do not cause symptoms. In fact, many people don’t realize they have one until it’s discovered by their doctor during testing.
Why do hiatal hernias matter?
A hiatal hernia increases your risk of gastro-esophageal acid reflux – the regurgitation of acid and gastric juice into the esophagus – which in turn causes discomfort and can increase the risk of pneumonia and cancer. Larger hernias can impede the passage of food into the stomach, impede breathing, and even rarely result in surgical emergencies if the stomach twists on its axis
What are the symptoms of a hiatal hernia?
- Heartburn (a burning sensation behind the breastbone)
- Regurgitation of food or liquids into your chest and into your mouth
- Chest or abdominal pain
- Difficulty swallowing
- Nausea and vomiting
- Shortness of breath
- Gastrointestinal bleeding
How do we diagnose hiatus hernias?
Your doctor may suspect a hiatus hernia, based on your symptoms. However, we establish the diagnosis definitively by endoscopy or by imaging (e.g. CT scanning, or barium upper GI X-rays).
How do we treat hiatal hernias?
In general, hernia-related symptoms respond at least partially to a combination of diet and lifestyle measures. For example, we instruct patients to remain upright for 2 hours after eating, and to avoid certain foods, such as heavy fatty suppers. Over the counter acid reducers such as common antacids may help, as do prescription strength acid reducers. Rarely, we need to intervene mechanically to fix the hernia. In the modern era, surgeons can return the stomach to its native position and anchor it there during a minimally invasive laparoscopic repair.
Hiatal Hernia Surgery: The minimally-invasive approach
If surgery is needed to repair a hiatal hernia, advances in minimally-invasive surgery make the procedure much easier than it used to be.
Today, hiatal hernia repair is done with laparoscopic surgery, which involves small incisions and faster recovery. Your surgeon will insert a tiny lighted camera into the incision to get a complete view of your internal situation. Then, using small tools, the surgeon will move your stomach back into place and secure and support the surrounding muscles using a mesh fabric.
This approach has been proven to permanently end symptoms for most people.
Your NYGA physician will assist you with navigating these treatment options and achieving a good outcome.
By: New York Gastroenteroloy
Published: Neville Bamji, MD
Last Reviewed: Mar 1st, 2022
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