Hiatal Hernias

A hiatal hernia occurs when a part of the stomach protrudes through a weakness in the diaphragm into the chest cavity. The weakness may be congenital, acquired after injury, or resulting from predisposing factors such as chronic straining, pregnancy or obesity.In some cases hiatal hernia surgery is necessary.

Hiatal hernias typically produce symptoms in older women. The symptoms are characteristic of acid reflux and can include any of the following:
• Repeated heartburn
• Regurgitation of food
• Chest pain
• Cough
• Hoarseness.

The diagnostic work-up of a hiatal hernia requires specialized testing including a barium swallow to visualize the esophagus using a special x-ray called fluoroscopy, an upper endoscopy to visualize the lining of the esophagus and stomach, and ph measurements of the esophagus. Other specialized tests are sometimes useful.

Initial treatment consist of conservative measures such as:
• Avoidance of large meals before lying down
• Smaller meals
• Elevation of the head of the bed
• Stopping smoking
• Avoidance of alcohol
• Avoidance of caffeine
• Avoidance of constricting clothing
• Weight loss

In addition to the above conservative measures, medications that suppress acid production have proven very useful in managing the symptoms. Antacids, H2 blockers such as Zantac or Pepcid, and proton pump inhibitors such as omeprazole are often used in the treatment plan.

Hiatal hernia surgery is indicated if the symptoms cannot be controlled or if there is a complication from the hiatal hernia. The surgical procedure performed consists of a laparoscopic approach to bringing the stomach out of the chest and back into the abdomen, repair of the weakness in the diaphragm (the hiatus), and wrapping a part of the upper stomach around the esophagus to control the symptoms and prevent recurrence. Patients are generally in the hospital for 1-2 nights and benefit from a quicker recovery with less pain using the laparoscopic approach.