What is a hiatal hernia?
Hiatal hernias occur inside of the abdomen through the diaphragm. The diaphragm is the muscle that separates the abdomen from the chest and is largely responsible for breathing. The esophagus passes through a small hole in the diaphragm as it enters into the abdomen. This hole in the diaphragm may enlarge over time and allow for the stomach or other structures in the abdomen to enter into the chest.
Hiatal hernias generally cannot be detected on a physical examination. In many cases, hiatal hernias are detected on an X-ray, CT scan or endoscopy.
Symptoms of a hiatal hernia
Hiatal hernias may result in a number of painful symptoms, including:
- Chest pain
- Difficult or painful swallowing
Hiatal hernias that are associated with these symptoms should be evaluated by a physician. Rarely, hiatal hernias may twist on themselves resulting in a gastric volvulus (twisted stomach). Patients with this condition require urgent surgical correction to prevent the stomach from dying. Symptoms of this condition may include all of the above plus nausea and vomiting.
Hiatal hernia is also one of the causes of gastroesophageal reflux disease (GERD), a chronic condition that causes liquid from the stomach to regurgitate into the esophagus. Not only is GERD painful, but it’s also a risk factor for esophageal cancer.
Treating a hiatal hernia
Not all patients with hernias will require surgery. However, hiatal hernias resulting in a gastric volvulus or those associated with the symptoms above generally require surgery.
Almost all hiatal hernias may be repaired utilizing laparoscopic surgery. There are many advantages to choosing a laparoscopic surgery over an open surgical approach, including:
- Quicker recovery time
- Decreased length of hospital stay
- A quicker return to normal activities
- Fewer incidences of hernia recurrence
- Fewer infections
Hiatal hernias are generally repaired with a biologic mesh. The mesh is placed at the site of the hole in the diaphragm and reduces the likelihood of hernia recurrence.