What Is A Hiatal Hernia?
A hiatal hernia is a defect in the diaphragm that allows movement of the stomach into the chest. The diaphragm is the muscle that divides the chest from the abdomen. There is a natural orifice (Hiatus) in the diaphragm where the esophagus goes through and meets the stomach in the abdomen. If this orifice (Hiatus) gets to large the stomach will tend to go up into the chest. A hiatal hernia is classified base on the size. Larger hiatal hernias are usually referred to as paraesophageal hernias.
What Causes Hiatal Hernias?
Many factors can contribute to hiatal hernia formation. The hiatus is a muscle and any condition that affects the muscle in any way can increase the chances of developing a hiatal hernia. Many of the risk factors below can increase the chances of other hernias.
- Sex: Female patients are four times more likely to develop hiatal hernias than the male counterpart.
- Age: Muscle mass decreases with age and the incidence of hiatal hernias increases exponentially with age.
- Genetics: If some of your close family members have developed hiatal hernias you have a higher risk of developing one.
- Trauma: Patients with a history of significant blunt trauma have a higher risk due to increased intra-abdominal pressure during the accident.
- Congenital: Hiatal or diaphragmatic hernias are rare in the pediatric population but when present they can be severe.
- Obesity: Increase intra-abdominal pressure due to obesity is a significant risk factor.
- Smoking or chronic respiratory conditions: Coughing is one of the things that increases intra-abdoimal pressure the most and subsequently increasing the risk of hernias.
- Heavy lifting: Occupations, sports or hobbies that require significant lifting are associated with an increased risk for hiatal hernias.
Symptoms Of Hiatal Hernias
Most patients with a hiatal hernia have no symptoms. This is particularly true for smaller hernias. Usually, as the hernia enlarges symptoms start to appear. Below you can see some of the most common symptoms.
- Heartburn or reflux
- Difficulty swallowing
- Upper abdominal or chest pain
- Shortness of breath
- Anemia from slow bleeding Cameron ulcers
- Low appetite or getting full quicker
- Bloating or indigestion
How Is A Hiatal Hernia Diagnosed?
Most hiatal hernias are found incidentally in patients that undergo studies for other conditions. In patients that present with some or several of the above symptoms, the physician will get other diagnostic studies.
The most common and least invasive diagnostic study is either an Upper GI Series or a CT scan. Both radiographic studies have good sensitivity in visualizing a hiatal hernia. This is particularly true in larger hernias. The upper GI series is the test of choice because it will also give the physician other valuable information. The study can diagnose esophageal reflux in combination with the hernia. It will also evaluate the swallowing mechanism as the test is done in real time while the patient is swallowing the contrast.
Upper endoscopy or EGD is the next test of choice. This is more invasive and it requires mild anesthesia. The study can diagnose hiatal hernias but also can show ulcers, inflammation, strictures, polyps and other conditions of the upper GI tract.
Hiatal Hernia Treatment
Should Every Hiatal Hernia Be Fix?
As we mentioned before, most hiatal hernias are asymptomatic. For that reason, surgical repair is usually not necessary for most patients. Having said that, a hiatal hernia will not go away by itself. They tent to enlarge with time and in most cases, they will become symptomatic as they grow.
For those patients with significant symptoms, surgical therapy is the best and only treatment. A laparoscopic hiatal hernia repair is the gold standard. This minimally invasive approach, when done by an experienced surgeon, is safe and highly effective.
Dr. Caban will perform the surgery through five small incisions. The largest incision is 12 mm in size. Using a TV screen and special instruments the hiatal hernia is dissected, the stomach is brought back down into the abdomen and the large diaphragmatic hiatus will be closed to the normal size with sutures.
The operative time is between one to two hours depending on the size of the hernia and prior surgical history.
In most cases, a hiatal hernia surgery is a two stage surgery. The standard of care is performing an antireflux procedure in combination with the hernia repair. The antireflux component is normally a Nissen Fundoplication or a Linx procedure.
The logic behind this is because reflux is one of the most common symptoms from a hiatal hernia. Repairing the hiatal hernia alone doesn’t guarantee that the reflux will resolve. For that reason, the two procedures are concomitantly done.
Doctor Caban will sit down with you and explained this to you in detail and he will help you decided what is the best option for you.
If you need more information please refer to this link where we discuss in more detail esophageal reflux disease.
Hiatal Hernia Surgery Recovery
What Happens After Hiatal Hernia Surgery?
Because the operation is done minimally invasive the patient will experience less pain, faster recovery and faster return to regular activities.
After surgery, you will be in the recovery room for 2-3 hours. Hospital admission for 1-2 days or discharge home on the same day of surgery will depend on several factors. Your overall medical condition and how you did during surgery is the first factor. The other main factor is the antireflux component like we explained above (Linx vs Nissen Fundoplication).
After a Linx procedure, you will be discharged home the same day of surgery with several days supply of pain medication. You will stop the antireflux medications immediately after surgery. Patients are encouraged to eat normal food right away to prevent stiffness of the device. Some discomfort is expected after swallowing, this will resolve spontaneously with time.
After a Nissen Fundoplication, most patients will be admitted to the hospital for 24-48 hours. They will be started on a clear liquid diet on day one and a full liquid diet on day two. Patients are required to stay on a full liquid diet for 2 weeks. The diet is advanced to a soft diet for two more weeks after that.
You will follow up with Dr. Caban in 2-3 weeks and at 3 months after surgery.
Most patients that have office type job can expect to return to work after 1-2 weeks. For those of you that have a heavy labor job were heavy lifting more than 15-20 pounds is necessary, you should account for 4-6 weeks out of work.
What People are Saying
“Dr. Angel Caban performed my surgery almost 5 years ago on 6/2/2014. He is a kind doctor and always treated me fairly. I always felt welcome in his office. I recommended him to many over the past 5 years”.
“Me encanta no lo cambio. Exelente el doctor caban y su personal. Muy buen grupo”.
“Another successful experience”
“Dr. Caban did my colon resection and did an outstanding job all the way across the board. I highly recommend him as well”.
“Very fortunate to have him”
“I have the privilege of working with Angel M Caban in the hospital environment. I also have had him be the surgeon to one of my family members. I would like everyone to know that he is a great surgeon. We are fortunate to have him here in Ocala. He is personable, easy to talk too and has excellent bedside manners”.
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