Hiatal Hernia FAQs
What is a hiatal hernia?
A hiatal hernia occurs when part of the stomach pushes up into the chest cavity through an opening in the diaphragm called the hiatus. It is the hole through which the esophagus attaches to the stomach. If the stomach pushes upward through a weakened area in the wall of the diaphragm, however, this results in a hiatal hernia and, often, symptoms of acid reflux.
What causes a hiatal hernia?
A hiatal hernia may be congenital or may develop over time. The majority of patients with hiatal hernias are over 50 years of age. Many factors may contribute to the development of hiatal hernias, including:
- Increasing age
- Injury to the area
- Being born with an unusually large hiatus
- Hard or persistent coughing, vomiting, or straining
What are the symptoms of a hiatal hernia?
The symptoms of a hiatal hernia may be mild or severe. They are the same symptoms of GERD, also known as gastroesophageal reflux disease, and include one or more of the following:
- Chest pain
- Difficulty swallowing
- Shortness of breath
How is a hiatal hernia diagnosed?
The physician often suspects a hiatal hernia because of the existence of one or more of the symptoms listed above. To confirm the diagnosis, tests will be performed, such as a barium X-ray, an endoscopy, or a manometry.
What is the treatment for a hiatal hernia?
Patients who have hiatal hernias may be able to limit their symptoms by following their doctors' advice. Eating smaller meals, avoiding eating before bedtime, elevating the head when reclining, all may be helpful. There are also medications, both over-the-counter and prescribed, which may alleviate or eliminate symptoms. These are antacids, H-2 receptor blockers and proton pump inhibitors which reduce or block the production of stomach acid. If none of these treatment options work, or if the hernia becomes incarcerated or strangulated, surgery may be the only option. If the hiatal hernia becomes obstructed, or if it becomes strangulated so that blood flow is inhibited, emergency surgery is required.
What is involved in the procedure to repair a hiatal hernia?
During hiatal hernia repair surgery, the patient is put under general anesthesia, but the procedure is usually done on an outpatient basis. The surgery is typically done laparoscopically so that scarring and pain will be lessened and recovery time will be shortened. In the event that open surgery needs to be done, the surgery will require a brief hospital stay. During the surgical procedure, the surgeon moves the protruding part of the stomach back from the chest cavity into the abdominal cavity and secures it in place. The stomach is wrapped around the end of the esophagus and fixed in position with stitches or staples. This is called Nissen Fundoplication and should prevent reoccurrence of the problem.
What are the risks of hiatal hernia repair?
The procedure itself is very safe and there are rarely complications. As with all surgeries, however, there are risks involved. In rare instances, a patient may experience excessive bleeding, breathing problems, reactions to anesthesia or medication, infection, or damage to adjacent organs.
What is the recovery from hiatal hernia repair surgery like?
The recovery from hiatal hernia surgery usually is a smooth one. Assuming that there have been no complications, the patient is generally able to return to normal activities within about a week. Immediately after surgery, rest and a soft diet is recommended. The patient may experience a loss of appetite, bloating, and/or flatulence in the immediate aftermath of the surgery, but these symptoms usually abate quickly. Some patients report difficulty swallowing, but this issue, too, usually resolves in a short time.