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Hiatus Hernia

What is a hiatus hernia?

A hiatal hernia is bulge through the back part of the diaphragm, where the oesophagus (gullet or food pipe) passes from the mouth to the stomach.

Normally, the stomach sits below the diaphragm, but in people with a hiatal hernia, the stomach pushes up through that hole, too.

There are 2 types of hiatus hernia

  • Sliding hernia - A sliding hernia happens when the top of the stomach pushes the lower oesophagus up into the chest This is the most common type of hiatal hernia.
  • Rolling (Paraesophageal) hernia - A paraesophageal hernia happens when the top of the stomach squeezes up past the side of the oesophagus. This is less common, but it can be serious if the stomach folds up on itself. It can also cause bleeding from the stomach or trouble breathing.

What are the symptoms of a hiatal hernia?

Hiatal hernias do not usually cause symptoms. In some cases, though, hiatal hernias cause stomach acid to reflux into the oesophagus (acid reflux or GORD). This can cause symptoms, including:

  • Burning in the chest, known as heartburn
  • Burning in the throat or an acid taste in the throat
  • Stomach or chest pain
  • Trouble swallowing
  • A raspy voice or a sore throat
  • Unexplained cough

What are the tests for hiatus hernia

As most people with hiatus hernias have reflux, the hernia is often diagnosed during the tests for gastro-oesophageal reflux disease (GORD).  Alternatively, a hiatus hernia may be found during an imaging test for an unrelated reason.

How are hiatal hernias treated

People who have symptoms caused by a hiatus hernia can get treated for their symptoms or have the hernia repaired.

Non-surgical treatment - Treatment for symptoms involves taking the medicines that are used for acid reflux.  In most cases surgery is not required, although the hernia may enlarge overtime.

Hiatus hernia surgery- People with a paraesophageal hernia, and some people with a sliding hernia will need surgery.  The size of the hernia, reflux symptoms and any complications of the hernia determine the need for surgery.

Laparoscopic hiatus hernia surgery - Most hiatus hernias can be repaired with laparoscopic surgery, making the recovery safer and less painful.

The surgery requires the placement of 4 or 5 small incisions over the upper abdomen.  The stomach is replaced into the abdomen and the hernia defect is sutured closed with strong stitches.  In some patients, an absorbable mesh is used to reinforce the repair, during the healing process.  An anti-reflux procedure is often required as part of this operation to control acid regurgitation

What should I expect after surgery?

Patients often experience the sensation of food sticking in the lower gullet for the first few weeks after surgery. It is recommended that for the first week after surgery a liquid-only diet is eaten, after the first week soft mushy foods can be eaten for the next two weeks.  After the first three weeks, normal diet can be resumed cautiously.  Some patients may feel increasingly bloated or gassy especially after drinking carbonated drinks.

Post-Op Recovery (Hiatus hernia repair / Anti reflux surgery)