Hiatal hernias happen when the muscle opening in the diaphragm called the esophageal hiatus weakens. Common causes include:
- Age-related muscle weakening
- Increased pressure in the abdomen that can be caused by obesity, pregnancy, or heavy lifting
- Chronic coughing or vomiting
- Genetic factors
- Cigarette smoking or use of nicotine products
Some patients may have no symptoms associated with the hiatal hernia. Others may experience symptoms such as:
- Heartburn or acid reflux
- Chest pain
- Difficulty swallowing
- Regurgitation of food or liquids
- Shortness of breath, especially with exertion
- History of anemia
A hiatal hernia is diagnosed through imaging or endoscopy. Smaller hernias can initially be managed through lifestyle changes such as eating smaller portions, staying upright after the last meal of the day, not going to bed right after a meal, and avoiding overeating.
Some people may need antacids as well as prescription medication to help manage their symptoms. While medications may help alleviate symptoms, they do not affect the hiatal hernia itself.
It is important to note that most hernias grow over time and become larger. Larger hernias have a smaller risk of gastric volvulus, which is a surgical emergency.
A hiatal hernia can be treated through minimally invasive surgery. Using laparoscopic and/or robotic technology, small incisions are made in the abdomen and the whole of the hernia is repaired using surgical sutures (stiches). Sometimes unabsorbable mesh may also be used.
Often, another anti-reflux procedure is added to help with symptom control. In this procedure, a part of the stomach is wrapped around the esophagus or swallowing tube. This helps to prevent acid reflux or GERD.
The use of minimally invasive techniques allows for faster recovery after surgery. The Mercy General Surgery clinic currently includes one night stay in the hospital after surgery.
Pain after surgery:
Your team will come up with a treatment plan to manage pain after surgery. In most cases, pain is mild and manageable through medication. Some patients may also have shoulder pain after surgery.
Diet after surgery:
Patients meet with a dietitian after surgery and receive instructions on dietary choices after surgery.
Immediately after surgery, a diet slowly advances from a liquid diet to full liquid and then to a soft diet. Most patients can return to regular food four to six weeks after surgery.
Activity following surgery:
Following surgery, patients should avoid heavy-lifting or strenuous activities. The duration and extent of the restriction is unique to each patient and is discussed with the surgical team.
Walking is encouraged immediately after surgery, and activities such as walking up and down stairs are also permissible.
Activities that require a lot of core strength such as swimming, abdominal exercises, yoga, or Pilates can put stress on surgical repair and should be avoided following surgery, your surgical team