The
term "Hernia" draws origin from the Greek latin word which means "tear"
or "rupture". Anatomically it refers to any abnormal protrusion of the
abdominal contents.
A "Hiatal Hernia" therefore refers to the
abnormal protrusion of the Gastrointestinal Tract through the opening
(hiatus) within the diaphragm.
There are two main types of hiatal hernias: sliding hiatal hernias, and paraesophageal hiatal hernias.
Sliding
hiatal hernias form when the stomach and the adjoining oesophagus slide
up into the chest cavity through the diaphragm. It is more common.
Paraoesophgeal
hernias are less common and it occurs when a portion of the stomach
squeezes past the diaphragm and is lodged and strangulated in place
beside the oesophagus. Such hernias can be asymptomatic but dangerous
because the portion of stomach that is strangulated above the diaphragm
will have a compromised blood supply.
In most cases, hiatal
hernias are asymptomatic but sometimes patients might experience
heartburn or reflux. While the two conditions appear to be linked, they
do not independently cause the development of the other.
In some
cases of heartburn, patients might experience chest pain instead and
this can be confused with chest pain caused by cardiac issues.
Causes
Often,
the cause remains unknown. However, any condition predisposing to an
increased pressure within the abdomen such as pregnancy, obesity,
coughing or straining during bowel movements, and/or congenital
situations such as a larger hiatal opening will predispose a person to
developing one.
Population at risk for developing Hiatal Hernias
There's a predisposition for women, overweight individuals, and patients above fifty years of age to develop this condition.
Diagnosis
A
hiatal hernia can be diagnosed with a specialized X-ray called a barium
swallow that allows a doctor to see the esophagus or with endoscopy.
The procedure involves the patient swallowing a radio-opaque liquid and
having X-Rays of the chest and abdomen taken while in the erect posture.
The radio-opaque liquid will outline the stomach lining and oesophagus,
thereby demonstrating the presence/absence of the condition.
Treatment
If
asymptomatic, no treatments are necessary. However, should the stomach
become strangulated and there is a risk of vascular compromise to the
stomach, surgery is usually needed to rectify the problem.
Other associated symptoms such as reflux disease, heartburn and chest discomfort should be treated accordingly.
When is Hiatal Hernia surgery necessary?
Surgery is indicated when the hernia becomes strangulated and the blood supply becomes compromised.
Surgical
intervention for hiatal hernias is often performed laparoscopically (ie
keyhole surgery) and is a day procedure. A camera and surgical tools
are inserted via keyhole incisions into the abdomen and the surgeon will
manipulate the surgical tools to reduce the hernia and possibly tighten
the diaphragmatic hiatus. The procedure is usually done as a day
procedure, involves smaller incisions, and has less pain and scarring
compared to open surgery.
Most patients will be able to ambulate
and walk around the next day. There are no dietary restrictions post
surgery and patients resume regular activities after a week or so.
Complete recovery will take up to a month and the patient should avoid
hard labour and heavy lifting.
When Should I Call the Doctor About a Hiatal Hernia?
Speak
with your doctor if you are symptomatic. It is difficult to diagnose
and symptoms include chest pain, recurrent nausea and vomiting, poor
bowel movements and non-specific symptoms like a funny sensation in the
middle of the chest.
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