Treatment and Causes of Hiatal Hernia Repair

Hiatal hernia repair are a common gastrointestinal issue affecting people of various age groups, especially those over 50. This condition occurs when the upper part of the stomach bulges through the diaphragm into the chest cavity. While many individuals may not experience symptoms, others may face significant discomfort requiring medical or even surgical intervention.

This can result in a range of uncomfortable symptoms, particularly related to acid reflux and indigestion, though some people may not experience any symptoms at all. While small hiatal hernias may go unnoticed or require only conservative management, larger or symptomatic hernias can lead to significant complications if left untreated, including gastroesophageal reflux disease (GERD), esophageal ulcers, and even strangulation of the stomach in severe cases.

What Is Hiatal Hernia Repair?

A hiatal hernia develops when the muscle wall separating the chest from the abdomen, known as the diaphragm, weakens or is stretched, allowing part of the stomach to push upward through the hiatus an opening in the diaphragm for the esophagus. This protrusion can lead to symptoms like acid reflux, heartburn, chest pain, and difficulty swallowing.

Hiatal hernias are generally classified into two types :-

1. Sliding Hiatal Hernia :- The most common type, where the stomach and lower esophageal sphincter slide in and out of the chest.

2. Paraesophageal Hiatal Hernia :- Less common but potentially more serious, this occurs when part of the stomach pushes up beside the esophagus and stays there, posing a risk of strangulation.

Treatment and Causes of Hiatal Hernia Repair

Common Causes of Hiatal Hernia

Several factors can contribute to the weakening of the diaphragm and the development of a hiatal hernia. Understanding these causes can help in early prevention and management.

1. Age Related Muscle Weakness :- As people age, the muscles of the diaphragm may naturally weaken, making older adults more prone to hiatal hernias. This age related change is a primary cause in many cases.

2. Increased Abdominal Pressure :- Any condition or activity that increases pressure in the abdomen can contribute to the development of a hiatal hernia. This includes :-

   • Persistent coughing or sneezing

   • Heavy lifting or straining

   • Obesity

   • Pregnancy

   • Chronic constipation leading to straining during bowel movements

3. Congenital Defects :- Some people may be born with an unusually large hiatus, making them more susceptible to developing a hernia later in life. Genetic predispositions and connective tissue disorders may also play a role.
4. Trauma or Injury :- In rare cases, trauma to the chest or abdomen such as from a car accident or previous surgical procedures can lead to the formation of a hiatal hernia.

Symptoms to Watch For

Although many hiatal hernias are asymptomatic, others can cause noticeable and sometimes severe symptoms, especially when the hernia allows stomach acid to back up into the esophagus.

Common symptoms include :-

1. Frequent heartburn or acid reflux

2. Regurgitation of food or liquids

3. Chest or upper abdominal pain

4. Trouble swallowing

5. Shortness of breath (in larger hernias)

6. Feeling full quickly after eating

In the case of a paraesophageal hernia, symptoms might be more serious and could include severe chest pain, vomiting, or gastrointestinal bleeding, which warrant immediate medical attention.

Diagnosing a Hiatal Hernia Repair

A hiatal hernia is usually diagnosed through imaging tests such as :-

1. Barium Swallow X-ray :- This test helps outline the upper digestive tract and reveals any abnormal positioning of the stomach.

2. Upper Endoscopy :- A flexible tube with a camera is inserted down the throat to visualize the esophagus and stomach directly.

3. Esophageal Manometry :- Measures the rhythmic muscle contractions of the esophagus and helps assess the function of the lower esophageal sphincter.

These tests assist healthcare providers in determining the size and type of hernia, guiding treatment decisions.

Non Surgical Treatment of Hiatal Hernia Repair

Not all hiatal hernias require surgery. In fact, most sliding hiatal hernias can be managed with lifestyle modifications and medications aimed at reducing acid reflux and associated discomfort.

1. Lifestyle Changes :- Certain lifestyle adjustments can significantly relieve symptoms and prevent progression :-

   • Eating smaller meals more frequently

   • Avoiding foods that trigger reflux (like spicy or acidic foods)

   • Losing excess weight

   • Elevating the head of the bed during sleep

   • Avoiding lying down immediately after eating

   • Quitting smoking, as it relaxes the lower esophageal sphincter

2. Medications :- Doctors may prescribe medications such as :-

   • Antacids for quick relief of heartburn

   • H2 receptor blockers to reduce stomach acid production

   • Proton pump inhibitors (PPIs) for more long-term acid suppression and healing of the esophagus

   These treatments help control symptoms, but they do not repair the hernia itself.

Surgical Treatment: When Is Hiatal Hernia Repair Needed?

Surgery is generally recommended for larger or paraesophageal hernias that cause persistent symptoms, complications, or have a risk of strangulation. It may also be considered when medication fails to provide adequate relief.

1. Laparoscopic Hiatal Hernia Repair :- The most common surgical approach today is laparoscopic hiatal hernia repair, a minimally invasive procedure that offers faster recovery and less postoperative discomfort. In this procedure :-

   • Small incisions are made in the abdomen.

   • The stomach is pulled back into the abdomen.

   • The hiatus is tightened.

   • Often, a fundoplication is performed wrapping the upper part of the stomach around the lower esophagus to strengthen the sphincter and reduce acid reflux.

   This surgery is typically performed under general anesthesia and may require an overnight hospital stay. Recovery usually takes a few weeks, with most patients returning to normal activities within a month.

2. Open Surgery :- In rare cases where laparoscopic surgery is not feasible due to complications or previous surgical history, open surgery may be required. This involves a larger incision and a longer recovery period.

Post Surgery Recovery and Outlook

After hiatal hernia repair, patients are generally advised to :-

1. Eat soft foods for the first few weeks

2. Avoid lifting heavy objects

3. Follow up with their surgeon to monitor healing

4. Slowly return to regular activity with their doctor’s guidance

The long-term outlook after surgery is typically very good, with most patients experiencing significant relief from symptoms. However, there’s a small chance the hernia could recur, especially if lifestyle risk factors persist.

Preventing a Hiatal Hernia

While not all hiatal hernias can be prevented, particularly those due to age or congenital defects, certain preventive strategies may reduce your risk :-

1. Maintain a healthy body weight

2. Exercise regularly to strengthen core muscles

3. Avoid heavy lifting or straining

4. Treat chronic coughing or constipation

5. Eat a balanced, high fiber diet

Early detection and management play a key role in preventing complications and reducing the need for surgical repair.

Conclusion

Hiatal hernias are common and often manageable with lifestyle changes and medication. However, in more serious cases or when symptoms severely impact quality of life, hiatal hernia repair surgery becomes a safe and effective solution.