Our Summary

This research paper reviews the latest studies on hiatal hernias, which are a common condition often found during radiographic or endoscopic exams. Hiatal hernias, while usually symptom-free, can sometimes cause symptoms or even lead to serious complications like organ damage due to lack of blood supply. The researchers found that about 1% of symptom-free hiatal hernias become symptomatic every year.

For symptom-free hernias, doctors usually recommend a “watch and wait” approach. Hernias that cause symptoms or are associated with acid reflux disease need to be treated with surgery. The standard surgical treatment involves removing the hernia sac, ensuring a certain length of the esophagus is within the abdomen, reinforcing the opening in the diaphragm where the esophagus passes through with mesh, and performing a procedure to prevent acid reflux.

In some cases, if the standard steps are not feasible, doctors may opt for an alternative procedure, which involves attaching the stomach to the abdominal wall and creating an artificial opening in the stomach.

The study concludes that hiatal hernias are often found incidentally and when they cause symptoms or are associated with acid reflux, surgical repair is necessary. The authors note that a less invasive surgical approach is safe and leads to better outcomes.

FAQs

  1. What is the rate at which asymptomatic hiatal and paraesophageal hernias become symptomatic and require repair?
  2. What is the recommended treatment for symptomatic hiatal hernias and those with confirmed reflux disease?
  3. How safe and effective is the minimally invasive approach for hiatal hernia repair?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hiatal hernia repair is to follow post-operative instructions carefully, including avoiding heavy lifting and strenuous activities for a certain period of time, eating smaller meals, and taking prescribed medications as directed. It is important to attend follow-up appointments with your doctor to monitor your recovery and ensure that the hernia has been successfully repaired.

Suitable For

Patients who are typically recommended hiatal hernia repair include those with symptomatic hiatal hernias, confirmed reflux disease, and giant paraesophageal hernias. Asymptomatic hernias may also require repair if they become symptomatic or show signs of complications such as organ ischemia or volvulus. Watchful waiting is appropriate for asymptomatic hernias, but operative repair with an anti-reflux procedure is usually necessary for symptomatic cases. Minimally invasive laparoscopic hernia repair is often preferred and has shown to have improved outcomes. Key operative steps include reduction and excision of the hernia sac, crural closure with mesh reinforcement, and an anti-reflux procedure. Patients with repairs not amenable to these key steps may undergo alternative procedures such as gastropexy and gastrostomy placement.

Timeline

Before hiatal hernia repair:

  1. Patient may experience symptoms such as heartburn, chest pain, difficulty swallowing, regurgitation, and feeling of fullness.
  2. Diagnostic workup may include imaging studies such as barium swallow, upper endoscopy, and pH monitoring to confirm the presence of a hiatal hernia and assess for complications such as reflux disease.
  3. Treatment may include lifestyle modifications, medications to manage symptoms, and avoiding trigger foods.

After hiatal hernia repair:

  1. Patient undergoes operative repair of the hiatal hernia, which may include reduction and excision of the hernia sac, crural closure with mesh reinforcement, and an anti-reflux procedure.
  2. Key operative steps are performed to ensure a successful repair and prevent recurrence of the hernia.
  3. Minimally invasive approaches such as laparoscopic hernia repair are preferred for improved outcomes and faster recovery.
  4. Post-operatively, patients may experience some discomfort and may need to follow a modified diet to allow for healing of the surgical site.
  5. Long-term follow-up may include monitoring for symptoms of recurrence and complications, as well as potential need for additional interventions.

What to Ask Your Doctor

  1. What are the symptoms of a hiatal hernia and when should I consider surgery for repair?
  2. What diagnostic tests are needed to confirm the presence of a hiatal hernia?
  3. What are the potential risks and complications associated with hiatal hernia repair surgery?
  4. What is the recovery process like after hiatal hernia repair surgery?
  5. Will I need to make any lifestyle changes or follow a specific diet after the surgery?
  6. How long will it take for me to fully recover and return to normal activities?
  7. Are there any alternative treatment options to surgery for a hiatal hernia?
  8. How often will I need follow-up appointments after the surgery?
  9. What is the success rate of hiatal hernia repair surgery?
  10. Are there any long-term effects or considerations I should be aware of after the surgery?

Reference

Authors: Siegal SR, Dolan JP, Hunter JG. Journal: Langenbecks Arch Surg. 2017 Dec;402(8):1145-1151. doi: 10.1007/s00423-017-1606-5. Epub 2017 Aug 21. PMID: 28828685