A hiatal hernia occurs when part of the stomach pushes upward through the diaphragm into the chest cavity. The diaphragm normally has a small opening (hiatus) through which the food tube (esophagus) passes on its way to connect to the stomach. The stomach can push up through this opening and cause a hiatal hernia. If the hernia is very large, other abdominal organs such as the intestines or liver can also push into the chest cavity.
- Most people do not have any symptoms with a small hiatal hernia
- Discomfort or pain in the middle abdomen or chest
- Bloating or belching
- Sharp abdominal pain and vomiting can mean the stomach is twisted or strangulated. This is a surgical emergency and immediate treatment is needed.
Several studies are needed to evaluate a hiatal hernia before an operation. You typically need a CT (computed tomography) scan or a barium swallow study to get images of the hernia. An endoscopy procedure called esophagogastroduodenoscopy (EGD) is needed to look at the inside of the stomach and esophagus. Esophageal manometry is needed to measure the strength and muscle coordination of your esophagus when you swallow. Sometimes swallowing studies or pH studies are also needed. The surgeon needs information from all of these studies to determine the best type of operation to repair the hernia.
Can it be Treated Without Surgery?
Sometimes symptoms from a hiatal hernia can be treated without surgery. Weight loss, avoiding acidic foods, decreasing food portions, quitting smoking and some acid-reducing medications can decrease symptoms from the hernia.
What Does the Surgery Involve?
If the hernia is large or symptoms don't improve, then patients may need an operation. Surgery involves pulling the hiatal hernia back into the abdomen and creating an improved valve mechanism at the bottom of the esophagus and closing the hole in the diaphragm muscle. Sometimes, the surgeon wraps the upper part of the stomach (called the fundus) around the lower portion of the esophagus. This creates a permanently tight sphincter so that stomach contents will not reflux back into the esophagus.
Laparoscopic Hernia Repair
The hernia is repaired through instruments placed into small incisions in the abdomen. The abdomen is inflated with carbon dioxide gas to make it possible to see the internal organs. The hernia is pulled back into the abdomen and the hole in the diaphragm is closed through these small incisions. If the stomach is wrapped around the esophagus, it is also done through the small incisions and this is called a fundoplication.
Open Hernia Repair
A larger incision is made in the abdomen. The hernia is pulled back into the abdomen and the hole in the diaphragm is closed. If the stomach is wrapped around the esophagus, it is also done through the same incision and this is called a fundoplication.