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Hiatus Hernia Surgery

A Hiatus Hernia is a condition in which the upper part of the stomach moves up through a small opening in the diaphragm into the chest. The diaphragm is the muscular wall that separates the abdominal cavity from the chest cavity.

The different types of Hiatus Hernias include:

  • Sliding Hiatus Hernia—The most common type in which the herniated part of the stomach slides back and forth, into and out of the chest.

  • Fixed Hiatus Hernia—The upper part of the stomach permanently remains in the chest.

  • Complicated Hiatus Hernia—Several other types of stomach herniation may be seen. These are uncommon but more serious and may require surgery.


Causes

Many people are born with the Hiatus Hernia but the cause is still unknown. It may result from a weakening of the supportive tissues.


Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.


Risk factors include:

  • Age: 50 or older

  • Obesity

  • Smoking

  • Pregnancy

  • Abdominal injury

  • Increased pressure in the abdomen from:

    • Severe coughing

    • Vomiting

    • Straining

    • Sudden physical exertion (eg, weight-lifting)

Symptoms

Most people with Hiatus Hernias have no symptoms.

Symptoms may occur when stomach acid moves up into the esophagus. This is known as gastroesophageal reflux disease (GERD) and can cause:

  • Heartburn, especially after eating or lying down

  • Pain or discomfort in the stomach, chest, or esophagus (swallowing tube)

  • Belching

  • Hoarseness

  • Throat irritation (frequent clearing of the throat)

  • Chest pain

  • Difficulty swallowing

  • Bleeding from the stomach or esophagus


Diagnosis

Because they often have no symptoms, Hiatus Hernias are sometimes only detected during a visit to the doctor for other ailments. A Hiatus Hernia is usually diagnosed with the following tests:

  • Upper GI series—A series of x-rays of the upper digestive system taken after drinking a barium solution, to show the outline of the digestive system.

  • Endoscopy—A camera mounted on a thin, lighted tube is inserted through the mouth into the esophagus or swallowing tube. At this time, a biopsy or sample of tissue may be taken to check for any complications, including:

    • Inflammation

    • Scar tissue

    • Abnormal cells called Barrett's esophagus that can develop into cancer

Treatment

Hiatus Hernias are usually treated only when there are symptoms. When GERD is present, the following measures may help:


Weight Loss

For people who are obese, losing weight may relieve symptoms.


Dietary Changes

Avoid foods that can relax the muscle that controls the opening between the esophagus and the stomach including:

  • Chocolate

  • Peppermint

  • Fatty foods

  • Coffee

  • Alcoholic beverages

Avoid foods and beverages that can irritate the internal lining of the esophagus, such as:

  • Caffeine

  • Citrus fruits and juices

  • Tomato products

  • Hot peppers

  • Carbonated beverages

To minimize acid reflux:

  • Consume smaller meals 4 to 6 times a day versus three large meals

  • Avoid drinking large amounts of fluids with meals

  • Do not eat within 2 to 3 hours of bedtime


Smoking Cessation

If you smoke, stop. Smoking weakens the lower esophageal sphincter, a muscle that controls the opening between the esophagus and the stomach.


Reduce Pressure on Your Abdomen

  • Wear clothes and belts that are loose around your waist

  • Avoid stooping or bending after meals, which puts increased pressure on the abdomen


Elevation

Elevating the head of the bed on 6-inch blocks or sleeping on a specially designed wedge reduces heartburn. This position helps prevent stomach contents from refluxing backward into the esophagus.


Antacids

Antacids can neutralize acid and temporarily relieve heartburn.


Surgery

Surgery may be needed if:

  • You have severe GERD symptoms that do not respond to other treatments.

  • The hernia is at risk for twisting, which could cut off the blood supply to part of the stomach and cause that part to die.

 

Hiatus Hernia Treatment

Treatment of large para-esophageal hernias causing symptoms requires surgery. During surgery, the stomach is pulled down into the abdomen, the esophageal hiatus is made smaller, and the esophagus is attached firmly to the diaphragm. This procedure restores the normal anatomy.

Since sliding hiatus hernias rarely cause problems themselves but rather contribute to acid reflux, the treatment for patients with hiatus hernias is usually the same as for the associated GERD. If the GERD is severe, complicated, or unresponsive to reasonable doses of medications, surgery often is performed. At the time of surgery, the hiatus hernia is eliminated in a manner similar to the repair of para-esophageal hernias. However, in addition, part of the upper stomach is wrapped around the lower sphincter to augment the pressure at the sphincter and further prevent acid reflux.


Why India

Hiatus Hernia treatment at India is the most preferred option in international patients at low cost. These days it seems like every country in the world promotes itself as a heaven for medical tourism. The reality is that in most cases they offer sub-standard facilities and limited skills/qualifications. India has tens of thousands of skilled physicians and nurse practitioners for treatment. Over the last two decades, the economic boom in India has led to the building of medical facilities & infrastructure that rival the very best that western medical care that the west has to offer. Many of the physicians that practice in these hospitals and clinics have returned (to India) from the U.S. and Europe, leaving behind successful practices. While some small countries may be viable as alternatives for minor surgical procedures, India is the only mainstream option that offers a comprehensive solution for any and all medical needs, and does this with the highest levels of service, facilities and professional skills.

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