Hiatus Hernia Surgery

Celebrities who have suffered from Hernia

Amitabh Bachchan

Dwayne Johnson

Denise Richards

Amazing Facts About Hiatus Hernia

• Not always Symptomatic: Not everyone with a hiatus hernia experiences symptoms. In some cases, the hernia is discovered incidentally during medical imaging tests. However, when symptoms do occur, they can range from mild to severe and may include heartburn, regurgitation, chest pain, difficulty swallowing, and belching. (Source)

• Doesn’t always need surgery: Treatment for hiatus hernia depends on the severity of symptoms and associated complications. Lifestyle modifications, such as eating smaller meals, avoiding trigger foods, losing weight, and elevating the head of the bed, can help alleviate symptoms. Medications such as antacids, proton pump inhibitors, and H2 blockers may be prescribed to reduce acid production. In severe cases or when complications arise, surgical intervention may be necessary to repair the hernia. (Source)

4 Reasons for Early Treatment of Hiatus Hernia

1. Symptom management: Early treatment can help manage symptoms such as heartburn, acid reflux, chest pain, and difficulty swallowing associated with hiatus hernia, improving the individual’s overall comfort.
2. Prevention of complications: Early treatment can prevent potential complications like gastroesophageal reflux disease (GERD), esophagitis, and Barrett’s esophagus, which can lead to more serious health issues if left untreated.
3. Preservation of esophageal health: Timely treatment can preserve the integrity of the esophagus and prevent long-term damage caused by the constant exposure to stomach acid due to the hernia.
4. Improved quality of life: Early treatment can alleviate symptoms and improve the individual’s quality of life, allowing them to eat, sleep, and engage in daily activities without the discomfort and limitations imposed by the hernia.

Complications of Untreated Hiatus Hernia

1. Gastroesophageal Reflux Disease (GERD): Untreated hiatus hernia can lead to the development or worsening of GERD, a condition where stomach acid flows back into the esophagus. This can cause symptoms such as heartburn, regurgitation, chest pain, and difficulty swallowing.
2. Esophagitis: Chronic exposure of the esophagus to stomach acid due to untreated hiatus hernia can result in inflammation of the esophageal lining, known as esophagitis. This can lead to pain, difficulty swallowing, and potentially serious complications such as bleeding or narrowing of the esophagus.
3. Stricture Formation: Prolonged untreated hiatus hernia can cause the development of strictures, which are narrowed areas in the esophagus. Strictures can make swallowing difficult and may require medical intervention or surgery to alleviate the obstruction.
4. Barrett’s Esophagus: In some cases, untreated hiatus hernia can contribute to the development of Barrett’s esophagus, a condition where the cells lining the lower esophagus change in response to chronic acid exposure. Barrett’s esophagus is a precancerous condition that increases the risk of esophageal cancer if left untreated. Regular monitoring and management are necessary to prevent the progression of Barrett’s esophagus to cancer.

What is Hiatus Hernia?

Risk Factors to develop Hiatus Hernia

1. Age: Hiatus hernias are more common in older individuals. The risk increases with age as the muscles and tissues supporting the diaphragm may weaken over time.
2. Obesity: Excess weight and obesity can put increased pressure on the abdomen and contribute to the development of a hiatus hernia. The additional weight can push the stomach upward through the diaphragm opening.
3. Pregnancy: Pregnancy can increase the risk of developing a hiatus hernia due to the pressure exerted on the abdomen by the growing uterus. Hormonal changes during pregnancy can also weaken the muscles and ligaments, making them more susceptible to herniation.
4. Smoking: Smoking can weaken the lower esophageal sphincter (LES), the muscle responsible for closing off the stomach from the esophagus. A weakened LES can allow stomach acid to flow back into the esophagus, contributing to the development of a hiatus hernia.
5. Genetics: There may be a genetic component to the development of hiatus hernias, as they can run in families. Individuals with a family history of hiatus hernias may be at a higher risk.
6. Chronic coughing or straining: Conditions that cause chronic coughing, such as chronic obstructive pulmonary disease (COPD) or persistent straining due to constipation, can increase the risk of developing a hiatus hernia. The repeated pressure on the abdomen can weaken the muscles and contribute to herniation.
7. Connective tissue disorders: Certain connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, may increase the risk of developing a hiatus hernia. These conditions can affect the strength and integrity of the connective tissues in the body, including those supporting the diaphragm.

Symptoms of Hiatus Hernia

• Heartburn,
• Regurgitation of stomach acid, 
• Chest pain, 
• Difficulty swallowing, and 
• a feeling of fullness after meals. 

Diagnosis of Hiatus Hernia

1. Medical History: The doctor will begin by asking about the patient’s medical history, including any symptoms experienced and their duration. They will inquire about any risk factors or predisposing factors for developing a hiatus hernia.
2. Physical Examination: The doctor will perform a physical examination to assess the patient’s abdomen and chest. They may gently press on the abdomen to feel for any abnormalities or perform a maneuver called a Valsalva maneuver to check for hernia protrusion.
3. Imaging Tests: Diagnostic imaging tests may be recommended to confirm the diagnosis and evaluate the size and position of the hiatus hernia. These may include: a. Upper Gastrointestinal (GI) Endoscopy: This procedure involves inserting a flexible tube with a camera (endoscope) through the mouth and into the esophagus and stomach. It allows the doctor to directly visualize the esophagus and stomach and assess the presence and characteristics of a hiatus hernia. b. Barium Swallow X-ray: In this test, the patient drinks a liquid containing barium, a contrast material, which coats the esophagus and stomach. X-ray images are then taken, allowing the doctor to observe the movement of the barium and detect any abnormalities, including a hiatus hernia. c. Esophageal Manometry: This test measures the pressure and coordination of the muscles in the esophagus. It can help assess the function of the lower esophageal sphincter (LES) and determine if there is any dysfunction contributing to the development of a hiatus hernia.

Treatment of Hiatus Hernia

Laparoscopic Hiatus Hernia Surgery

Benefits of Laparoscopic Hiatus Hernia Surgery

1. Minimally invasive: Laparoscopic surgery involves smaller incisions, resulting in reduced scarring, less postoperative pain, and faster recovery compared to open surgery.
2. Improved outcomes: Laparoscopic repair has shown excellent long-term outcomes in terms of symptom relief and improvement in quality of life.
3. Reduced hospital stay: Patients who undergo laparoscopic surgery for hiatus hernias typically experience shorter hospital stays and quicker return to normal activities.

Preparation for Hiatus Hernia Surgery

1. Consultation with a Surgeon: Schedule a consultation with a surgeon who specializes in hiatus hernia surgery. During this appointment, the surgeon will assess your hernia, review your medical history, and discuss the surgical options available to you.
2. Medical Evaluation: Your surgeon may request certain medical evaluations to assess your overall health and determine your eligibility for surgery. These may include blood tests, imaging studies (such as an upper gastrointestinal (GI) endoscopy), and an electrocardiogram (ECG) to evaluate your heart function.
3. Medication Review: Inform your surgeon about all the medications you are currently taking, including prescription drugs, over-the-counter medications, and supplements. Your surgeon will provide instructions on which medications to continue or discontinue before the surgery.
4. Fasting: You will be instructed to fast for a specific period of time before the surgery. This is typically about 8 hours for solid food and 2 hours for clear liquids. Fasting helps reduce the risk of complications during the procedure.
5. Anesthesia Consultation: If general anesthesia or sedation will be used during the surgery, you may need to schedule a separate consultation with an anesthesiologist. The anesthesiologist will evaluate your medical history, discuss the anesthesia options available, and address any concerns you may have.
6. Lifestyle Adjustments: Your surgeon may recommend certain lifestyle adjustments to optimize your health before the surgery. This may include quitting smoking, maintaining a healthy weight, and managing any underlying conditions, such as gastroesophageal reflux disease (GERD). These measures can help reduce the risk of complications and promote a faster recovery.
7. Preoperative Instructions: Follow any preoperative instructions provided by your surgeon. These may include guidelines on when to stop eating and drinking before the surgery, instructions on showering with antibacterial soap, and details about any required bowel preparation.
8. Support and Assistance: Arrange for a family member or friend to accompany you to the surgery and help with transportation and postoperative care. Having support during the recovery period can greatly aid in your comfort and well-being.

Anaesthesia for Hiatus Hernia Surgery

1. General Anesthesia: In general anesthesia, the patient is completely unconscious and unaware during the surgery. It is administered by an anesthesiologist through intravenous medications and inhaled gases. General anesthesia allows for complete relaxation of the patient’s muscles, ensuring optimal surgical conditions. The patient is closely monitored throughout the procedure to maintain vital signs and ensure safety.
2. Local Anesthesia with Sedation: In some cases, hernia surgery may be performed under local anesthesia with the addition of sedation. Local anesthesia involves injecting a numbing medication into the surgical area to block pain sensation. Sedation is administered through intravenous medications to help the patient relax and remain comfortable during the procedure. With this type of anesthesia, the patient is usually awake but feels drowsy and relaxed.

Recovery after Hiatus Hernia Surgery

1. Hospital Stay: The length of your hospital stay will depend on the extent of the surgery and your overall health. In some cases, hiatal hernia surgery can be performed as an outpatient procedure, allowing you to go home on the same day. However, in more complex cases or if there are any complications, an overnight hospital stay may be required.
2. Pain Management: It is normal to experience some pain and discomfort in the chest or abdomen after the surgery. Your doctor will prescribe pain medications to help manage post-operative pain. Take the medications as instructed and report any severe or worsening pain to your healthcare provider.
3. Incision Care: If your surgery involved making incisions, proper care of the surgical site is important for preventing infection and promoting healing. Follow your surgeon’s instructions on how to keep the incisions clean and dry. You may need to change dressings regularly and apply any recommended ointments. Avoid soaking in baths or swimming until your healthcare provider gives you the go-ahead.
4. Dietary Modifications: Your surgeon or a dietitian will provide specific dietary instructions to follow after hiatal hernia surgery. This may include consuming smaller, more frequent meals, avoiding foods that trigger reflux or heartburn, and maintaining a healthy weight. It is important to adhere to these dietary guidelines to minimize discomfort and promote healing.
5. Physical Activity: During the initial recovery period, it is essential to limit physical activity and avoid strenuous activities that may strain the surgical site. Your surgeon will provide guidance on when you can gradually resume regular activities and exercise. Gentle walking is often encouraged to promote blood circulation and aid in digestion, but avoid heavy lifting or intense workouts until cleared by your healthcare provider.
6. Medications: Your surgeon may prescribe medications to reduce stomach acid production and manage any underlying conditions that contribute to hiatal hernia. Take all medications as directed and report any side effects or concerns to your healthcare provider.
7. Follow-up Appointments: Attend all scheduled follow-up appointments with your surgeon. These visits allow your surgeon to monitor your healing progress, remove any stitches or staples if necessary, and address any concerns or complications that may arise.
8. Lifestyle Modifications: To prevent a recurrence of the hiatal hernia and manage related symptoms, your healthcare provider may recommend certain lifestyle modifications. This may include maintaining a healthy weight, avoiding tight-fitting clothing, elevating the head of your bed while sleeping, quitting smoking, and avoiding alcohol and foods that trigger reflux.
9. Signs of Complications: Be vigilant for any signs or symptoms that may indicate complications, such as excessive bleeding, severe pain, persistent fever, difficulty swallowing, chest pain, or difficulty breathing. If you experience any of these symptoms, contact your healthcare provider immediately.

Risks and side effects of Hiatus Hernia Surgery

1. Potential complications: As with any surgical procedure, there are potential risks involved, including bleeding, infection, injury to surrounding structures, and anesthesia-related complications.
2. Hernia recurrence: Although the recurrence rate is low, there is a possibility of the hiatus hernia returning after surgery.
3. Postoperative discomfort: Some patients may experience mild discomfort, bloating, or difficulty swallowing temporarily after the surgery, which can usually be managed with pain medication and a suitable recovery plan.