A hiatal hernia differs from other abdominal hernias in that it occurs inside the abdomen, when an intra-abdominal viscera, usually the upper part of the stomach, bulges into the chest cavity through an opening (hiatus) in the diaphragm. The treatment of hiatal hernia depends on its type.
What are the different types of hiatal hernia?
There are two main types of hiatal hernia: sliding and paraesophageal (next to the esophagus).
The most common of the two is a sliding hiatal hernia, in which the gastroesophageal junction slides into the chest.
In paraesophageal hernia, the upper part of the stomach (the fundus) penetrates the chest while the gastroesophageal junction remains in its place.
When both the gastroesophageal junction and the fundus of the stomach bulge into the thoracic cavity, the hiatal hernia is called a mixed one.
What are the risk factors for hiatal hernia?
The most important risk factor for hiatal hernia is chronic increased intra-abdominal pressure. But there are other causes that have been associated with its occurrence.
Overall, the main causes of hiatal hernia are:
- Increased intra-abdominal pressure as a result of chronic cough, constipation, weightlifting, obesity or pregnancy
- Increased contractility of the esophagus
- Advanced age
What are the symptoms of a hiatal hernia?
Small hiatal hernias may be asymptomatic and discovered incidentally during gastroscopy. However, as the condition progresses, mild to severe discomforts appear. It is worth noting that hiatal hernia is the most important cause of gastroesophageal reflux.
As a result, the symptoms of hiatal hernia are largely identical to the symptoms of gastroesophageal reflux disease. The most common symptoms are:
- Indigestion and dysphagia
- Burning pain in the chest
- Bloating and belching
- Abdominal discomfort
- Bitter and/or sour taste in the throat
How is hiatal hernia diagnosed?
To diagnose a hiatal hernia, the patient’s complete medical history is required. The following diagnostic methods contribute to a more accurate diagnosis as well as to formulating the right treatment plan for each patient:
- CT scan of the chest and upper abdomen
- X-ray of stomach esophagus with barium swallow
- Esophageal pH monitoring
- Esophageal manometry
- Radiological testing using contrast media
- Gastric Emptying Study
How is hiatal hernia treated?
In the early stages of hiatal hernia, conservative treatment is the first option. The Doctor suggests the inclusion of physical exercise in the patient’s daily routine. In addition, when gastroesophageal reflux is present, medication is also recommended.
Moreover, the symptoms of hiatal hernia can be reduced through a balanced diet. The adoption of a Mediterranean diet can bring about excellent results.
At the same time, it is important that meals are consumed in small and frequent amounts and that they are chewed well before swallowing.
In cases of obesity, weight loss is deemed necessary for dealing with the symptoms of the condition.
The main indications for surgical treatment are:
- failure of conservative treatment to control symptoms
- recurrence of symptoms
- complications due to gastroesophageal reflux
Surgical treatment of hiatal hernia includes minimally invasive techniques (Laparoscopic or Robotic repair) carried out through small incisions of 5-10 millimeters.
During the operation, the part of the stomach that has moved into the chest is brought back in its original position.
At the same time, the normal gastro-oesophageal valve in the upper part of the stomach is reconstructed (fundoplasty).
This valve prevents recurrence and stops gastroesophageal reflux, so that the contents of the stomach are not pushed back to the esophagus. If the hiatal hernia opening is large, then the diaphragm may require mesh reinforcement.
With surgical treatment, the vast majority of patients are completely relieved of symptoms.
General Surgeon Pericles Chrysocheris has extensive experience in both modern invasive techniques (Laparoscopic and Robotic Surgery) for the treatment of hiatal hernia, having applied them in a multitude of cases of varying severity.
Do not hesitate to contact him for the immediate and specialized treatment of the problem you are facing.