An Understanding of Hiatal Hernia
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.
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.
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.
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.
Dr Tzun Hon Lau is a resident housecall doctor at CMY Medical with more than a decade of experience in home care in Singapore. He is a strong believer that comprehensive healthcare at home does not need to cost an arm and a leg.
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