Hiatus Hernia

What is a Hiatus Hernia?

The hiatus is a naturally occurring opening in the diaphragm that allows the oesophagus to pass from the chest into the abdomen and connect with the stomach. When this opening starts to widen or weaken, this allows some or all of the stomach to go up into the chest and we have a hiatus hernia. This can be broadly divided into 2 types; the sliding and para (meaning next to) oesophageal hernia.

Hiatus Hernia-1

What are the risk factors for Hiatal hernias?

  • Obesity
  • Constant coughing or straining
  • Congenital (Diaphragmatic hernia)
  • Increasing age (fibromuscular degeneration)

What can be the symptoms of someone with a hiatal hernia?

  • Chest pain
  • Heart burn
  • Difficulty swallowing
  • Vomiting
  • Shortness of breath
  • Anaemia (Cameron Erosions/Ulcers)

What complications can I get from a Hiatus hernia?

  • Gastro-oesophageal reflux disease (GORD)
  • Oesophagitis (resulting from GORD)
  • Oesophageal Stricture (prolonged GORD)
  • Barretts Oesophagus (Changes in the lining of the oesophagus resulting from prolonged exposure to GORD)
  • Strangulated Hernia – Requires emergency surgery
  • Uppergastrointestinal bleed (oesophagitis / cameron ulcers)

Do all hiatus hernias need to be surgically repaired?

Not all hiatus hernias need to be repaired. Each person needs to be considered on their individual history, examination and investigations. Broadly speaking in the absence of reflux disease a type 1 hiatus hernia does not need surgical repair. SAGES Guidelines 2013.

Do asymptomatic Hiatus hernias need to be repaired?

To better answer this question we need to have an understanding of the disease we are dealing with. Essentially this is a disease of the diaphragm. Like any hernia defect it will get bigger with time. This increases the complexity along with the morbidity of the surgery the bigger it gets. Some of the evidence from published literature put the risk of progression from asymptomatic to symptomatic paraoesophageal hernias up to 14%. The risk of developing acute symptoms requiring emergency surgery is about 1%.

What are the types of surgery available for Symptomatic Hiatus hernias?

This surgery in Australia is mostly performed as key hole’ or laparoscopic surgery. The principle is to reduce the contents of the hernia (stomach, small bowel, large bowel, spleen or liver) from the chest into the abdomen and ideally have at 2-3 cm of the oesophagus sitting in the abdomen without any tension. Following this, the closure of the hiatus is performed. Depending on the patient’s individual circumstances the additional use of mesh or wrap might be needed.

How long is my recovery time from this surgery?

Typically most patients would go home on day 2 after the surgery. This may vary depending on the patients co-morbidities and the intra-operative findings.

What can I eat after the surgery?

This can vary with individual circumstances, but broadly most patients will be on free fluids for up to 2 weeks post surgery. A complete avoidance of bread and steak during this time is advised.

Why can’t I eat solid food after my surgery?

The aim of the operation is to close the defect around the oesophagus. This can make it difficult for solid food bolus to pass through resulting in difficulty swallowing and regurgitation and vomiting. The increase in abdominal pressure with this regurgitation and vomiting can result in damaging the repair and closure of the hiatus.

Will I lose weight after my surgery?

It is not uncommon to lose some weight after the operation but generally most people have regained any lost weight at 3 -6 months.