What is a Hiatal Hernia?
A hiatal hernia occurs when the upper part of the stomach pushes up into the chest through a small opening in the diaphragm, the muscle that separates the abdomen from the chest. A hiatal hernia results in retention of acid and other contents, since the stomach tends to get squeezed by this opening in the diaphragm. These acids and other substances can easily back up (reflux or regurgitate) into the esophagus.
There are four types of hiatal hernias:
- Type I or sliding hiatal hernia
- In this type, the stomach intermittently slides up into the chest through a small opening in the diaphragm.
- Types II, III, and IV hiatal hernias are called paraesophageal hernias.
- They happen when a portion of the stomach pushes up into the chest adjacent to the esophagus. They may have a significant portion of their stomach or other abdominal organs push up into their chest.
Most of the time, a hiatal hernia does not cause symptoms. Though some common symptoms that can be present in all four types are:
- Regurgitation – or backflow of stomach content into the esophagus or throat.
More severe symptoms are usually associated with a paraesophageal hernia. Those signs and symptoms include:
- Intermittent difficulty swallowing, especially solid foods.
- Feeling full after eating only a small amount of food
- Abdominal or chest pain
- Abdominal bleeding shows up as:
- red blood in vomit
- dark red or black stools
- blood loss
- on a blood test.
What about severe cases?
In severe cases, the stomach or abdominal organs may rotate or twist, causing severe pain. This is a medical emergency and will likely require immediate surgery.
How will we find out how severe my hernia is?
Dr. Kolachalam will perform a medical exam and medical history. Dr. Kolachalam will also need a:
- Chest X-ray
- Upper Endoscopy
- Barium swallow
- Manometry, a test to measure the pressure in the esophagus
At what point is surgery needed?
Medication may be prescribed by Dr. Kolachalam to neutralize stomach acid, decrease acid production, or strengthen the lower esophageal sphincter. The esophageal sphincter is the muscle that prevents stomach acid from coming up into the esophagus. Surgery may also be needed in these cases to reduce the size of the hernia, or to prevent strangulation by closing the opening in the diaphragm.
The common reasons for surgery include but not limited to:
- In danger of becoming strangulated (twisted in a way that cuts off blood supply to the stomach).
- Complicated by severe gastroesophageal reflux disease (GERD).
- Complicated by esophagitis (inflammation of the esophagus).
What types of surgery are available to me?
Three major types of surgical procedures correct gastroesophageal reflux and repair the hernia in the process. They can be performed by open laparotomy or with laparoscopic approaches, which currently are being employed more frequently. These procedures offer relief of symptoms in 80-90% of patients.
- da Vinci® surgery – minimally invasive surgery
- Laproscopic surgery – minimally invasive surgery
- Open Surgery – rarely done