SURGERY FOR HIATUS HERNIAS

Hernia Repair Details

Some people with a hiatus hernia may not experience any symptoms, but when symptoms do occur, they may include:

• Heartburn: A burning sensation in the chest or throat, usually after eating or when lying down

• Acid reflux: When stomach acid flows backward into the oesophagus, causing irritation or discomfort

• Regurgitation: A sensation of food or liquid coming back up into the mouth

• Difficulty swallowing (dysphagia)

• Chest pain & Shortness of breath: Often confused with the pain of a heart attack. Larger hiatus hernias can often cause significant pressure on the heart and lungs

• Belching: Frequent burping or bloating

• Nausea: Especially after eating

In some cases, a paraesophageal hiatus hernia can cause more serious symptoms, such as severe chest pain, inability to eat or drink anything, or difficulty breathing, which requires immediate medical attention

A hiatus hernia can develop for a variety of reasons, including:

• Weakness in the diaphragm: As we age, the diaphragm can become weaker, allowing part of the stomach to push through

• Increased pressure on the abdomen: Conditions that increase pressure, such as obesity, pregnancy, heavy lifting, or chronic coughing, can contribute to the development of a hiatus hernia

• Genetic factors: Some people may inherit a tendency to develop a hiatus hernia due to weaker diaphragmatic muscles

• Age: The risk of developing a hiatus hernia increases with age, as tissues naturally weaken over time

• Congenital: Rarely, some people are born with defects in parts of their diaphragm, which can result in organs from the abdomen, herniating into the chest

Diagnosis

To correctly diagnose a hiatus hernia and prepare you for surgery, Dr. Stokes may organise one or multiple of the following investigations:

1. CT Scan of the Chest & Abdomen

2. Barium Swallow (“Live” screening X-ray whilst swallowing contrast dye)

3. Gastroscopy

4. Oesophageal Manometry

People with a hiatus hernia who do not have symptoms, typically do not require surgery.

If a person is symptomatic from their hiatus hernia and they are “fit” for an operation, then surgery is recommended.

Surgery (Hiatus hernia repair) is the only treatment option available that “fixes” the mechanical, anatomical problem. Dr. Stokes & Dr. Hammerschlag specialise in the minimally invasive surgical repair of hiatus hernias, using laparoscopic and robotic (Da Vinci) approaches.

Treatment options include:

1. Lifestyle Changes:

• Eating smaller, more frequent meals: This can reduce pressure on the stomach and oesophagus

• Avoiding trigger foods: Foods that cause acid reflux, such as spicy, fatty, or acidic foods, should be avoided

• Raising the head of the bed: If symptoms worsen at night, elevating the head of your bed can help prevent acid reflux

• Weight loss: If you are overweight, losing weight may help reduce the pressure on your abdomen and improve symptoms

• Quit smoking: Smoking can worsen symptoms and delay healing of the oesophagus
  

2. Medications (help to relieve symptoms)

• Antacids: These over-the-counter medications help neutralize stomach acid and help lessen the symptoms to some degree

• H2 blockers: These medications reduce the production of stomach acid

• Proton pump inhibitors (PPIs): These drugs decrease stomach acid.

• Prokinetic agents: These medications help improve the movement of food through the digestive tract and reduce reflux
  

3. Surgical Treatment:

• Recommended when the patient is symptomatic despite the above measures, and “fit” for an operation

• Surgery can usually be performed minimally invasively (keyhole)

• A laparoscopic hiatus hernia repair involves reducing all the organs that have abnormally herniated into the chest, repairing the diaphragm with sutures, and finally a fundoplication, whereby the top part of stomach is wrapped around the lower part of oesophagus, helping create an “anti-reflux” valve, but also help to “hold” the stomach down in the abdomen

• Laparoscopic Hiatus Hernia Repair Surgery offers numerous advantages including small incisions on the abdomen, less pain and scarring, less bleeding and drastically faster recovery after surgery and shorter hospital stays

Following minimally invasive Hiatus Hernia & Fundoplication surgery, most patients stay in hospital 1-3 nights. When discharged, our surgeons will provide you with a comprehensive “patient information sheet” outlining expected recovery times, dietary guidelines and activity restrictions.

The aim is to fully inform you to support you in your post operative period to achieve the best possible outcome after surgery.