Laparoscopic Hiatus Hernia Repair

A hiatus hernia occurs when the upper part of the stomach bulges through an opening in the diaphragm into the chest. The diaphragm is a muscle, located between the abdomen and chest, has a small opening called the hiatus where the esophagus passes from the chest to connect with the stomach in the abdomen. When a portion of the stomach pushes through this opening, a hiatus hernia is formed.

Types of Hiatus Hernia

Sliding Hiatus Hernia

This is the most common type of hiatal hernia. It occurs when the stomach and esophagus slide in and out of the chest through the hiatus. These hernias are generally small and often don’t cause any symptoms.

Rolling or Paraesophageal Hiatus Hernia

This type is rarer and occurs when part of the stomach becomes stuck in the diaphragm. While often not severe, there’s a risk of blood supply being cut off to the stomach, creating a medical emergency that requires immediate treatment.

Mixed Hiatus Hernia

(Combination of the above)

Symptoms of Hiatal Hernia

Common symptoms include:

• Heartburn
• Acid reflux
• Chest pain
• Abdominal discomfort
• Shortness of breath
• Vomiting
• Difficulty swallowing
• Bloating
• Backflow of food or liquid from the stomach to the mouth

Immediate medical attention is needed if you experience severe chest or belly pain, inability to pass stool or gas, or persistent stomach upset.

Causes of Hiatal Hernia

Hiatal hernias typically result from a weakened diaphragm muscle that allows part of the stomach to push through. Common causes include:

• Injury to the abdominal area
• Congenital defect (large hiatus)
• Age-related changes in the diaphragm
• Increased pressure in the abdomen due to persistent coughing, vomiting, or lifting heavy objects

Diagnosis of Hiatal Hernia

Tests for diagnosis include:

• Barium Swallow: A liquid with barium is ingested, and X-rays are taken to view the digestive tract.
• Upper Endoscopy: A flexible tube with a camera is inserted to examine the esophagus and stomach.
• Esophageal Manometry: Measures the rhythmic muscle contractions of the esophagus.
• pH Test: Assesses the acid levels in the esophagus.
• CT Scan: Used to diagnose complications like gastric volvulus or perforation.

Treatment of Hiatal Hernia

Medications

While there are no medications to treat the hernia itself, doctors may prescribe antacids, acid-blocking medications, and proton pump inhibitors to relieve symptoms

Lifestyle Changes

• Eat smaller frequent meals throughout the day
• Avoid acidic and reflux-triggering foods
• Lose weight if necessary
• Avoid lying down after eating
• Elevate the head while sleeping

Surgical Treatment

Laparoscopic Hernia Repair

This minimally invasive procedure involves making small incisions in the abdomen. A laparoscope is inserted to view and repair the hernia. A mesh may be used to tighten the hiatus and prevent recurrence.

Nissen Fundoplication

In this procedure, the upper portion of the stomach is wrapped around the lower esophagus to reinforce the hiatus and prevent acid reflux.