A hiatal hernia occurs when a part of the stomach bulges into the chest cavity through a weak spot or defect diaphragm. People with hiatal hernias may think they go away on their own with no treatment. But in most of the cases, one should undergo either open hernia repair surgery or laparoscopic hiatal hernia repair surgery to treat and repair the hernia. We keep discussing the hiatal hernia and its treatment options throughout the article.

What is Hiatal hernia

When there is a weak spot or defect in the abdominal wall, internal organs or tissues may protrude through it forming a bulge or lump called a hernia.

 A hiatal hernia occurs where a part of the stomach pushes into the chest cavity because of a weak spot or defect in the diaphragm. Patients with hiatal hernia cannot feel or see a bulge. So, one should consult the doctor before a hiatal hernia gets worse and causes some serious problems.

One can suffer from many other types of hernias such as inguinal hernia, epigastric hernia, femoral hernia, umbilical hernia, and incisional hernia.

Hiatal hernia causes

Most of the hernias are caused because of either a birth defect in the abdominal wall or due to strain. However, a common cause of hiatal hernia in most of the reported cases is an increase in pressure in the abdominal cavity. A few of the reasons the pressure may increase in the abdominal cavity are:

  • Lifting heavy objects
  • Physical strain
  • Excessive cough
  • Strain during coughing
  • Straining during a bowel movement.

Other reasons for the development of hiatal hernia are during pregnancy, accumulation of fluid in the abdomen, and overweight.

When surgery is required for hiatal hernia

If hiatal hernia symptoms are not relieved through lifestyle modifications and medications, then the doctor may suggest you undergo hernia repair surgery. In a few cases, a portion of the stomach that enters the chest cavity may get squeezed too tightly that blood supply may cut off, and in such one should get immediate medical attention.

Laparoscopic hiatal hernia repair with mesh

Open surgery and laparoscopic hiatal hernia repair surgery are used to treat hiatal hernia. Among them, laparoscopic surgery is widely chosen by most patients. Laparoscopic surgery is minimally invasive, decreases loss of blood, less pain & scarring, shorter recovery, a better quality of outcomes, less risk of infection, and involves small incisions compared to open surgery.

The laparoscopic technique of repairing a hiatal hernia is safe and effective, which is an alternative to open surgery. Generally, surgeons will prefer laparoscopic hiatal hernia repair, and this called the Nissen fundoplication. This surgery involves:

  • Before the laparoscopic surgery, Anesthesiologists will sedate the patient using either local or general anesthesia.
  • All the vital signs like blood pressure [BP], heartbeat, pulse rate, and oxygen levels will be monitored throughout the surgery.
  • Once the patient is in stable condition, the surgeon will mark the areas of hiatal hernias.
  • Later, small incisions are made around the marked locations.
  • Now, a laparoscope [a small and narrow medical instrument that allows the surgeon to see inside the human body] is used to identify the fundus and weak spot of the diaphragm.
  • Next, the fundus will be wrapped around the esophagus, and the sphincter is tightened to avoid gastric reflux.
  • After that, a portion of the stomach will be pushed back, and a synthetic mesh will be placed over the weak spot of the diaphragm to provide the strength.
  • After completing the laparoscopic hiatal hernia surgery, the incisions made will be stitched together.

Hiatal hernia treatment

In most of the hiatal hernia patients, symptoms are noticed rarely. However, these symptoms are similar to gastric esophageal reflux disease [GERD], and the doctor primarily plans treatment options to reduce or to manage these symptoms. So, one should follow all the instructions and precautions to reduce the symptoms of hiatal hernia, and they include:

  • Restrict heavy meals or large portions of meals
  • Avoid consumption of acidic foods like tomato sauce and juices of citric fruits [orange, lemon, etc.]
  • Maintain a healthy diet and lose weight if you are obese [overweight]
  • Do not smoke or quit smoking
  • Avoid bedtime snacks
  • Place a pillow under the head while sleeping as this decreases the gastric reflux
  • Restrict eating fatty and fried foods
  • Do not drink caffeinated and carbonated beverages

Above are a few of the lifestyle modifications that help to treat hiatal hernia. Adding to these, other treatment options are wearing a truss, binder, or corset to push the hernia back and using over-the-counter medications like antacids and proton-pump inhibitors.

Keep in mind

A hernia can become dangerous that may even cause death if left untreated. So, look out for the symptoms of a hernia and consult the doctor before they become worse. Depending on the severity of the health condition of the patient and the size of a hiatal hernia, your doctor may suggest undergoing a laparoscopic hiatal hernia repair with mesh to treat hiatal hernias. Follow all the lifestyle modifications and precautions suggested by your healthcare provider.