Hiatus Hernia Surgery

A hiatus hernia occurs when a portion of the stomach squeezes, slides or protrudes through the gap in the diaphragm through which the esophagus passes.

There are 2 main types of hiatus hernia.

Sliding Hiatus Hernia

This is the most common type of hiatus hernia.

It occurs when the junction between the oesophagus and the upper part of the stomach moves up through the oesophageal opening in the diaphragm into the chest cavity.

The herniated portion of the stomach can slide back and forth, into and out of the chest.

Rolling Hiatus Hernia

This is sometimes called a para-oesophageal hernia. In this case, part of the stomach bulges into the chest through the weakest part of the diaphragm, which is the oesophageal opening.

The junction of the oesophagus and stomach stays down within the abdomen, and the top part of the stomach (the fundus) bulges up into the chest cavity.

This type of a hernia normally remains in one place, sitting next to the oesophagus, and does not move in or out when you swallow.

What are the Symptoms of a Hiatus Hernia?

Most people are not troubled by their hiatus hernia, but if reflux of the acid contents of the stomach occurs (called gastro-oesophageal reflux), you may experience heartburn. This is a painful burning sensation in the chest.

Sudden regurgitation of acid fluid into the mouth can occur, especially when you lie down or bend forward. These symptoms are a problem when you go to bed and can wake you up.

Other symptoms include belching, pain on swallowing hot fluids and a feeling of food sticking in the oesophagus. Rarely excruciating abdominal pain occurs where the blood supply is cut off to that part of the stomach that has protruded into the chest. Nausea, vomiting and loss of appetite indicate an intestinal obstruction.

Conservative Management for General Hernia Symptoms

The following measures mainly are recommended to control and relieve the symptoms but the surgery is the only potentially definite corrective treatment.

General guidelines for treating heartburn and oesophagitis (inflammation of the oesophagus) are:

Avoid (or use only in moderation) foods and substances that increase reflux of acid into the oesophagus, such as:

nicotine (cigarettes)
caffeine
chocolate
fatty foods
peppermint
alcohol
spearmint

Eat smaller, more frequent meals and do not eat within 2-3 hours of bedtime.
Avoid bending, stooping, abdominal exercises, tight belts, and girdles all of which increase abdominal pressure and cause reflux.
If overweight, lose weight. Obesity also increases abdominal pressure.
Prescription medications.
Elevate the head of the bed 8 to 10 inches by putting pillows or a wedge under the upper part of the mattress. Gravity then helps keep stomach acid out of the esophagus while sleeping.

Other Treatments

Some medicines effectively reduce the secretion of stomach acid thereby reducing acid reflux.

Suitability for Hiatus Hernia Surgery

The complicated hiatus hernia requires surgery occasionally on an emergency basis. Surgery otherwise is reserved for those patients with symptoms that cannot be controlled with medications or noncompliant patients.

The mere presence of a hiatus hernia is not a reason for surgery. Surgical treatment is called for when a hernia results in symptoms, such as persistent heartburn or difficulty in swallowing.

Acid inflammation and ulceration of the lower oesophagus may also require treatment.

Laparoscopic Hiatus Hernia Repair

Hiatus hernia repair is normally done laparoscopically. This involves five small cuts in the abdomen, using the operating telescope (laparoscope) to return the stomach to the abdomen and reduce the size of the defect in the diaphragm.

Risks of Laparoscopic Hiatus Hernia Repair

There are some risks of laparoscopic hernia repair that are shared by all operations, these risks occur rarely. They include heart attack, stroke, a clot in the lungs (pulmonary embolus), significant bleeding, infection and injury to the bowel.

There are some risks that are specific to laparoscopic hiatus hernia repair:

A small number of hiatus hernia repair patients will require revision surgery for a recurrent hernia
Sometimes the hernia cannot be repaired with the laparoscope and an open repair is necessary.
Occasionally patients have difficulty swallowing after the operation.
Bloating and discomfort from gas buildup may occur because the person is not able to burp.
Excess gas.

Discharge from Hospital after Hernia Surgery

You will be able to go home a couple of days after the operation once you are comfortable and able to take a puree diet.

Recovery After the Hernia Surgery

When first at home

Try not to drink too much for the first 24 hours.
Do not drive for at least two days.
Do not partake in heavy lifting (nothing heavier than a bucket of water) or strenuous exercise for 6 weeks.
After one week - you can remove your dressings.
After two weeks - you should be able to return to work.