Hiatal Hernia

A hiatal hernia can be primarily classified into two categories: 

Sliding Hiatal Hernia:

The sliding hiatal hernia occurs when the stomach and oesophagus slide in and out of the chest through the opening. These are more common Hiatal hernias and usually don’t cause any symptoms. 

Fixed or Paraesophageal Hiatal Hernia:

These are rare kinds of hiatal hernia. In this, the part of the stomach is stuck through the diaphragm. In most cases, they are not severe, though, in some, there is a risk of the blood being cut off to the part of the stomach. This becomes a medical emergency and requires sudden treatment.

Some common symptoms for Hiatal hernias include: 

1. Heartburn
2. Acid reflux
3. Chest pain 
4. Pain in the abdominal area
5. Shortness of breath
6. Vomiting 
7. Difficulty in swallowing 
8. Passing of black stools
9. Bloating 
10. Backflow of food or liquid from the stomach to mouth

One should get immediate medical care if the following symptoms occur:

1. Severe pain in the chest or belly
2. Unable to pass stool or gas
3. Persistent upset stomach

It is believed that the condition occurs when the weakened muscle allows the stomach to bulge through the diaphragm and into the chest. Moreover, the hiatal hernia can also occur when there is too much pressure on the muscles in the abdominal area due to coughing, vomiting, lifting heavy objects, and more. Other causes may include

1. Injury in the abdominal area 
2. Congenital defect of considerably large hiatus
3. Age-related changes in the diaphragm

The doctor may perform the following tests to determine whether the patient is suffering from a hiatal hernia or not. These may include: 

Barium Swallow:

In this test, the doctor gives a liquid with barium to drink and then takes X-ray images to get a clearer view of the digestive tract. The images allow the doctor to see the location of protruding hernia.

Upper Endoscopy:

During this test, the doctor inserts a flexible tube that comes with a light and a camera at the top of the throat to the inside of the oesophagus and stomach to check for any inflammation. 

Oesophageal Manometry:

The test is performed to check the rhythmic muscle contractions of the oesophagus. 

pH Test:

The doctor runs a pH test to measure the acid levels in the oesophagus. 

CT Scan:

The test is done to diagnose the complications of hiatal hernia like gastric volvulus, perforation, and more.

Most people with hiatal hernia may not experience any symptoms and requires no treatment. However, in case of a larger hiatal hernia, the doctor may suggest the following treatment.

Medications of Hiatal Hernia

There are no medications to treat hiatal hernia however, the doctor may prescribe certain medicines to relieve the symptoms caused by hiatal hernia. These may include antacids to neutralize stomach acid. The doctor may also prescribe medicines to block acid production and heal the oesophagus. In some cases, the doctor may also suggest proton pump inhibitors. 

Lifestyle Changes

The doctor may also suggest some lifestyle changes in order to relieve the symptoms of hiatal hernia. The doctor may change the diet to reduce acid reflux and ask to avoid eating certain foods. The doctor may also suggest eating smaller meals several times a day and avoiding eating food or snacks within a few hours of sleep. Weight loss and having an active lifestyle to reduce the symptoms of hiatal hernia is also effective to an extent.

Surgery of Hiatal Hernia

Laparoscopic Hernia Repair:

Also known as keyhole surgery, the procedure is done by making a small incision in the abdomen. The surgeon then inserts a thin tube with a camera attached (laparoscope) into the incision. The camera sends images to the monitor, which aids the surgeon to repair the hernia through the small incision. The surgeon also uses a piece of mesh to tighten and decrease the size of the hiatus, which prevents the stomach from protruding through it. 

Laparoscopic Hernia Repair / Stomach Wrap / Nissen Fundoplication:

During this procedure, the surgeon makes an incision in the abdomen and then wraps the upper part of the stomach, known as the fundus, around the lower part of the oesophagus. The surgeon then closes the incision with stitches. 

Next-Generation Robotic Surgery:

The Next-Generation Robot, VERSIUS from CMR Surgical, Cambridge UK is designed to provide all the advantages of laparoscopic surgery with added precision and safety. Backed by Machine Learning and Artificial Intelligence, Versius is designed for surgical excellence. It enables a 3D view which gives a greater depth perception to the surgeon thus improving the accuracy, reducing the surgical time and in turn enhancing the safety of the procedure. The robot has an open console (unlike a closed tunnel like console of previous generation robots) which gives the surgeon complete access to the patient and team for close monitoring of all patient parameters during the procedure. Its robotic arms allow wide degree of movements that gives the surgeon unmatched flexibility for precise and efficient alignment thus overcoming the restrictions of a human wrist.

Some of the factors that may increase the risk of hiatal hernia include: 

1. Obesity
2. Smoking
3. Age of 50 and above

One can prevent hiatal hernia symptoms to an extent with lifestyle changes to reduce the acid reflux symptoms. However, this is not a treatment and will not cure the hiatal hernia defect. These may include: 

1. Avoid acidic good
2. Eat a healthy diet
3. Don’t wear tight clothes
4. Lose some weight
5. Eat-in smaller portion 
6. Don’t strain during bowel movements
7. Don’t lift heavy objects
8. Reduce the intake of alcohol, caffeine, or chocolate

In most cases, Hiatal hernias don’t cause any complications. However, in some cases, it may result in:

1. Gastroesophageal reflux disease
2. Lung problems
3. Strangulation of the hernia

The outlook for hiatal hernia is generally positive. People with these conditions usually have mild symptoms that may be managed with lifestyle changes. However, in some cases of larger hiatal hernia, the doctor may advise treatments like medications and lifestyle changes. In cases where GERD is associated with Hiatal hernia, surgery will be advised to repair the hernia and secure the defect with a mesh. 

• HERNIA: Definition, Causes, Symptoms & Treatment