Our Summary

Hiatal and paraesophageal hernias are conditions where part of the stomach or other organs protrude abnormally through the diaphragm. These can be present from birth, due to genetic factors or abnormalities when the baby is developing in the womb, or can occur after certain types of stomach surgery. One particular surgery, called a Nissen fundoplication, used to be associated with a high risk of causing these hernias, but changes to the way the surgery is done have reduced this risk from over a third of patients to about one in eight.

These hernias can cause a variety of symptoms, including problems with digestion and breathing, as well as more general symptoms like anemia (a lack of healthy red blood cells) and failure to thrive (poor growth and development). They are usually diagnosed using a chest x-ray and an examination of the upper part of the digestive tract.

The treatment for these hernias is usually surgery, which aims to push the protruding organs back into their correct place, remove the part of the stomach or other organ that has herniated, close up the hole in the diaphragm, and carry out a procedure to prevent stomach acid from flowing back into the esophagus (the tube that carries food from the mouth to the stomach). This surgery can be done using a technique called laparoscopy, which involves making small cuts in the abdomen and inserting a special camera and surgical instruments. This approach is considered safe and effective.

FAQs

  1. What are the common symptoms of a hiatal and paraesophageal hernia?
  2. How is a hiatal hernia diagnosed and treated?
  3. What is the risk of acquiring hiatal hernia after gastroesophageal surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about hiatal hernia repair is to follow the post-operative care instructions closely, including avoiding heavy lifting, eating smaller meals, and taking prescribed medications as directed. It is also important to attend follow-up appointments to monitor progress and address any concerns promptly. Staying active and maintaining a healthy weight can also help prevent recurrence of the hernia.

Suitable For

Patients who are typically recommended hiatal hernia repair include those with symptomatic hiatal hernias that are causing gastrointestinal, respiratory, and constitutional symptoms, as well as those with complications such as anemia and failure to thrive. Patients with associated gastroesophageal reflux are also candidates for hiatal hernia repair. In pediatric patients, hiatal hernia repair may be recommended for congenital hernias or acquired hernias following gastroesophageal surgery. Treatment is typically surgical, with the goal of reducing hernia contents, excising the hernia sac, closing the crura, and performing an antireflux procedure. The laparoscopic approach is often favored for its safety and effectiveness.

Timeline

  • Patient experiences symptoms such as gastrointestinal discomfort, heartburn, chest pain, difficulty swallowing, and regurgitation.
  • Patient undergoes diagnostic tests such as chest x-ray and upper gastrointestinal (GI) series to confirm the presence of a hiatal hernia.
  • Patient may be prescribed medications to manage symptoms and prevent complications.
  • Patient undergoes laparoscopic hiatal hernia repair surgery, which involves reducing the hernia contents, excising the hernia sac, closing the crura, and performing an antireflux procedure.
  • After surgery, patient may experience some discomfort and require a period of recovery.
  • Patient is advised to follow post-operative instructions, including diet and activity restrictions, to ensure successful healing.
  • Patient may experience improved symptoms and quality of life after hiatal hernia repair, with reduced risk of complications such as gastroesophageal reflux disease.

What to Ask Your Doctor

  1. What are the risks and benefits of having surgery to repair my hiatal hernia?
  2. What type of surgical procedure will be performed to repair my hiatal hernia?
  3. What is the expected recovery time after hiatal hernia repair surgery?
  4. Are there any lifestyle changes or dietary restrictions I need to follow after surgery to prevent hiatal hernia recurrence?
  5. What are the potential complications or side effects of hiatal hernia repair surgery?
  6. How long will it take for me to see improvement in my symptoms after surgery?
  7. Will I need to take any medications after surgery to manage my hiatal hernia?
  8. How often will I need follow-up appointments after hiatal hernia repair surgery?
  9. What is the long-term outlook for hiatal hernia repair surgery in terms of preventing future hernias or complications?
  10. Are there any alternative treatment options to surgery for repairing my hiatal hernia?

Reference

Authors: Garvey EM, Ostlie DJ. Journal: Semin Pediatr Surg. 2017 Apr;26(2):61-66. doi: 10.1053/j.sempedsurg.2017.02.008. Epub 2017 Mar 9. PMID: 28550872