How Do They Repair A Hernia On The Esophagus

Overview

What is a hiatal hernia?

A hiatal hernia occurs when the upper part of the stomach pushes through an opening in the diaphragm and into the chest cavity. The diaphragm is the thin muscle wall that separates the chest cavity from the abdomen. The opening in the diaphragm is where the esophagus and stomach join.

Who is at hazard for developing a hiatal hernia?

A hiatal hernia tin can develop in people of all ages and both sexes, although information technology frequently occurs in people age 50 and older. Hiatal hernia occurs more often in overweight people and smokers.

Symptoms and Causes

What causes a hiatal hernia?

The most common crusade of a hiatal hernia is an increase in pressure in the abdominal cavity. Your abdominal cavity is the space in the centre of your body that holds several organs, including the:

Lower part of the esophagus and breadbasket.
Small intestine, colon and rectum.
Liver.
Gallbladder, pancreas and spleen.
Kidneys.
Bladder.

This pressure can build upwardly from things like:

Coughing.
Vomiting.
Straining during a bowel movement.
Heavy lifting.
Concrete strain.

There are also other reasons a hiatal hernia could develop. You may feel a hiatal hernia during pregnancy, if you are obese, or if in that location's actress fluid in your belly.

A coughing man with hiatal hernia

Increased pressure in the belly (arrows) causes function of the tummy to push through the diaphragm and into the chest crenel.

What are the symptoms of a hiatal hernia?

Many people with a hiatal hernia never take symptoms. Some people with hiatal hernia take some of the aforementioned symptoms as gastroesophageal reflex disease (GERD). GERD occurs when digestive juices move from the stomach back into the esophagus. Symptoms of GERD include:

Heartburn.
Bitter or sour taste in the dorsum of the throat.
Bloating and belching.
Discomfort or pain in the tum or esophagus.

Although there appears to exist a link between hiatal hernia and GERD, one status does not seem to cause the other. Many people accept a hiatal hernia without having GERD, and others take GERD without having a hiatal hernia.

Another symptom of a hiatal hernia is breast pain. Since chest pain tin can as well be a symptom of a heart attack, it'south important to contact your healthcare provider or get to the emergency room if you experience whatever breast pain.

Diagnosis and Tests

How is a hiatal hernia diagnosed?

Several tests can be done to assist diagnose a hiatal hernia. These include a barium swallow test, an endoscopy process, esophageal manometric studies, a pH test and gastric emptying studies.

A barium swallow involves drinking a special liquid, then taking X-rays to help see problems in the esophagus (such as swallowing disorders) and the stomach (such as ulcers and tumors). Information technology as well shows how big the hiatal hernia is and if in that location is twisting of the breadbasket every bit a result of the hernia.
An endoscopy is a process in which the inside of the upper digestive system is viewed with an endoscope (a long, sparse, flexible musical instrument near 1/2 inch in diameter).
An esophageal manometry measures the strength and muscle coordination of your esophagus when y'all eat.
A pH test measures the acid levels in the esophagus and helps determine which symptoms are related to acid in the esophagus.
Gastric emptying studies examine how fast food leaves the breadbasket. Results from this examination are especially important in patients who accept nausea and vomiting. At that place could exist other causes of the nausea and vomiting also a hiatal hernia.

Management and Treatment

How is a hiatal hernia treated?

Most hiatal hernias do non crusade problems and rarely need handling. However, since some patients with a hiatal hernia have symptoms of GERD, treatment starts with methods used to manage GERD. These include making such lifestyle changes as:

Losing weight if you're overweight.
Decreasing the portion sizes of meals.
Fugitive sure acidic foods—such as tomato sauce and citrus fruits or juices—that can irritate the esophageal lining.
Limiting fried and fatty foods, foods or drinks containing caffeine (including chocolate), peppermint, carbonated beverages, alcoholic beverages, ketchup and mustard, and vinegar.
Eating meals at least three to iv hours before lying downwards, and avoiding bedtime snacks.
Keeping your head six inches higher than the residuum of your torso when lying on your back. Raising the level of your caput helps gravity keep your stomach'due south contents in the stomach. Raising the head of your bed past angling your mattress works best—piling your pillows doesn't piece of work too considering information technology makes you crisis your center instead of simply angling your body up.
Quitting smoking.
Not wearing a tight belt or tight habiliment that can increase the pressure level on the abdomen — such as command top hosiery and body shapers.
Taking medications subsequently eating to reduce acid in the stomach. These over-the-counter medications include antacids, Gaviscon®, or H-blockers (such as Pepcid Ac® or Zantac®).

Sometimes, a medication called a proton-pump inhibitor might be used to treat hiatal hernia. This medication is some other way to subtract the amount of stomach acid you accept, which can help preclude reflux. When y'all accept this medication, your body doesn't make as much stomach acid equally normal. This is like to H-blocker medications.

Can over-the-counter medications assistance relieve my hiatal hernia symptoms?

In many cases, over-the-counter medications can help you with some symptoms of hiatal hernia. Antacids are the most common medication you might utilize for relief. Even so, if yous accept over-the-counter medications for longer than two weeks without any improvement, see your healthcare provider. Prescription medications are typically the next step. These can include:

Pantoprazole (Protonix®).
Rabeprazole (Aciphex®).
Esomeprazole (Nexium®).
Omeprazole (Prilosec®).
Lansoprazole (Prevacid®).

When is surgery for a hiatal hernia needed?

If the portion of the tum entering the esophagus is existence squeezed so tightly that the blood supply is being cut off, you'll demand to take surgery. Surgery may likewise be needed in people with a hiatal hernia who take severe, long-lasting (chronic) esophageal reflux whose symptoms are not relieved by medical treatments. The goal of this surgery is to correct gastroesophageal reflux past creating an improved valve mechanism at the bottom of the esophagus. Retrieve of this valve equally a swinging door. It opens to let food pass downwards into the tum and and then closes to keep stomach contents from going back up the esophagus. When this valve doesn't piece of work correctly, your stomach contents can go the wrong way and damage your esophagus. If left untreated, chronic gastroesophageal reflux can cause complications such as esophagitis (inflammation), esophageal ulcers, bleeding or scarring of the esophagus.

How is surgery for a hiatal hernia performed?

Surgery for repairing a hiatal hernia involves:

Pulling the hiatal hernia back into the belly.
Improving the valve at the bottom of the esophagus.
Endmost the hole in the diaphragm muscle.

During surgery, your surgeon will wrap the upper part of the tum (called the fundus) around the lower portion of the esophagus. This creates a permanently tight sphincter (the valve) so that stomach contents will non move back (reflux) into the esophagus.

Called a fundoplication, in that location are 2 versions of this surgery. An open fundoplication surgery involves a larger incision. This type of procedure may need to exist done in some very severe cases and information technology allows for greater visibility during surgery. Nevertheless, open surgeries crave a longer recovery fourth dimension in the infirmary. In many cases, the surgeon will decide to employ a laparoscopic arroyo instead.

A laparoscopic surgery is done through several small incisions instead of one big cutting. This is considered a minimally invasive option. The specific laparoscopic procedure used to repair a hiatal hernia is called the Nissen fundoplication. This procedure creates a permanent solution to your hiatal hernia symptoms. During the procedure, your surgeon will make five or half-dozen tiny incisions in the abdomen. The laparoscope (a tool that allows the surgical squad to run across your internal organs on a screen in the operating room) and other surgical instruments are inserted through the small incisions. The fundus is wrapped around the esophagus and the sphincter is tightened during surgery. The advantages of laparoscopic surgery compared to an open up surgery include:

Smaller incisions.
Less risk of infection.
Less hurting and scarring.
A shorter recovery.

Outlook / Prognosis

How effective is surgery for a hiatal hernia?

A laparoscopic repair of hiatal hernia and reflux, called Nissen Fundoplication, is very constructive in most patients. This surgery requires general anesthesia and a short stay in the hospital. If you need to take an open surgical procedure, the recovery time will be longer and you may need to stay in the hospital for several days. After surgery, nigh patients no longer crave long-term treatment with prescription or over-the-counter antacid medications.