Hiatal Hernia

Hernia is a bulging of an organ or tissue through an unusual opening. For example, an organ may break through a weakened area in the abdominal wall. The abdomen is the most common site of hernia but they may occur on upper thighs, belly button and groin or inguinal areas. Most common types of hernias include an Inguinal hernia, Hiatal hernia, Umbilical hernia and Incisional hernia. Though most hernias are not fatal they may need to be repaired through surgeries to avoid complications which may prove to be dangerous. 
What is hiatal hernia?
The Hiatus is a small opening that separates the chest cavity from the abdomen. Whenever the stomach bulges up to the chest through this opening, it is called hiatal hernia. This may result in gastroesophageal reflux which is when the stomach contents leak backward into the esophagus, causing a burning sensation.This type of hernia is most common in people over 50 years old. If a child suffers from this condition, it may be caused by a congenital birth defect.

What causes Hiatal Hernia?
Though most of the times the reason of hiatal is not known, increased pressure in the abdomen due to pregnancy, obesity, coughing or straining during bowel movements may have an effect causing this type of hernia. Some people may be born with larger hiatus opening increasing the risk of hiatal hernias. 

Symptoms of Hiatal Hernia

  • Heartburn: chest pain, burning are common symptoms.
  • Nausea, vomiting or dry heaves may also occur and excessive burping can also be a sign.
  • Waterbrash, the rapid appearance of a large amount of saliva in the mouth that is stimulated by the refluxing acid.
  • Symptoms may worsen after having meals or lying flat which may provide momentary relief after sitting up or walking.

Treatment for Hiatal Hernia

The treatment for hiatal hernia is mainly treatment for gastroesophageal reflux disease and minimizing acid reflux. Decreasing acid secretion in the stomach, avoiding substances that are irritating to the stomach lining, and mechanical means to keep the remaining acid in the stomach where it belongs is the main procedure. 
Proton pump inhibitor medications are commonly used to decrease acid production. If the hernia possesses a threat to cut off the blood supply by causing the stomach to be strangulated, a surgery is recommended by doctors. Hiatal hernia may be operated by the laparoscopic method. It is one of the simplest methods of surgeries with advantages of less infection, less pain and speedy recovery. Patients who are operated by this method, are able to walk around the day after the surgery in most cases. There are some initial dietary restrictions and the patient may resume their regular activities after a week though complete recovery takes around three weeks time. The patient is only asked to not lift heavy weights after the operation. 

Complications of Hiatal Hernia

Although this type of hernia does not have symptoms, the danger is that the blood supply to the stomach can become strangled or cut off. Other complications may be chronic heartburn and inflammation of the lower esophagus, called reflux esophagitis. Chronic bleeding from the lower esophagus may cause anemia. Scarring and narrowing of the lower esophagus may cause difficulty in swallowing.


Authored By Dr G Parthasarathy - Surgical Gastroenterologist, Hyderabad