Treatment of Hiatal Hernia (hiatus Hernia)

About the disease

Hiatal hernia is a condition when hiatus, a small opening of the diaphragm, protrudes forward. During hiatal hernia stomach pushes forward through this small opening and causes the food and acid go back into esophagus. If hiatal hernia is small in size, it may never manifest itself and not result in any complications. If it is big in size, hernia can cause heartburn because of the acids which are pushed back into esophagus. Hiatal hernia can develop if diaphragm or stomach muscles are weakened. It can happen because of the age or constant pressure on the stomach, which can develop because of heavy lifting or constant coughing. Some people are born with an abnormally large hiatus, thus developing hernia later on in life. Obesity can also contribute to the development of hiatal hernia. It usually occurs after 55 years of age.    

The normal hiatus size is 2 cm. Patients with hiatal hernia can reach in size 4-5 cm. According to American site MedScape, this condition is most common in developed Western countries. 10% of patients, who are diagnosed with this disease, are younger than 40 and 70% are older than 70 years of age, which supports the notion that this disease is always age-related.  

Symptoms

• Heartburn
• Pain in the abdomen
• Feeling of fullness in the stomach at all times
• Difficulty swallowing
• Nausea
• Vomiting with blood
• Black stool

Diagnosis

• Blood test is the first diagnostic test for hiatal hernia, as the patients with this condition most often complain of heartburn and abdominal pain.
• Endoscopy is used to check esophagus and diaphragm for the signs of inflammation. During this procedure doctor inserts small tube, equipped with the light, down the patient`s throat.
• Barium swallow is the procedure, during which patient drinks special liquid with barium which creates the image of the stomach and diaphragm.     

Treatment

• Nissen fundoplication is a laparoscopic surgery, during which the upper part of the stomach is wrapped around the lower part of the esophagus and stitched in this place to reinforce the closing function of esophagus. This way stomach stops protruding into the diaphragm and the nutrition process is stabilized.
• Removal of the hernia sac is another surgical option, during which the hernia is resected and thus the acid does not go back to esophagus. Surgeon can also make the hiatus opening smaller to prevent the formation of new hernia in the future.

Overall, mortality rates for these surgeries are extremely low with the indicators less than 1%, which proves them to be safe and efficient.

Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed