Hiatal Hernia

A hiatal hernia is when the upper part of your stomach protrudes up into your chest through a small opening (hiatus) in the muscle that separates the two areas, called your diaphragm.

What is a hiatal hernia?

A hiatal hernia is when a part of your stomach pushes up through a hole in your diaphragm muscle, the muscle that separates your chest from your abdomen. If you have a hiatal hernia part of your stomach is in the lower part of your chest.

A hiatal hernia is also called a hiatus hernia as the opening in your diaphragm that your stomach pushes through is called the hiatus.

There are two main types of hiatal hernias:
  • Sliding hiatal hernia – by far the most common type of hiatal hernia. Your stomach intermittently slides up into your chest through the hiatus and back down and out of your chest area. A sliding hiatal hernia does not stay in a fixed position but it moves up and down. It is also known as a type 1 hiatal hernia.
  • Para-oesophageal hiatus hernia – a portion of your stomach pushes up into your chest next to your oesophagus and remains fixed or still. Paraesophageal hiatus hernias can be referred to as type II, III and IV hiatal hernias.

What are the symptoms of a Hiatal Hernia?

A hiatal hernia often causes no symptoms. Some people experience hiatal hernia symptoms that are similar to gastroesophageal reflux disease (GERD) symptoms. This is because GERD occurs when acid and digestive juices move from your stomach back into your oesophagus. These symptoms include:

  • Heartburn – a painful burning feeling in your chest, often after eating
  • An unpleasant bitter or sour taste in your mouth
  • Bringing up small amounts of food or liquids back into your mouth
  • Bloating or burping
  • Feeling or being sick
  • Bad breath
  • Trouble or pain swallowing
  • Discomfort or pain in your stomach
  • Shortness of breath

Some people may also suffer from hiatal hernia pain including chest and abdominal pain.

What are the causes of a hiatal hernia?

What causes a hiatal hernia is not entirely clear. However, hiatal hernia causes can include:

  • Congenital - being born with a larger than usual hiatal opening
  • Injury - to the hiatus area
  • Ageing – may weaken your diaphragm. Hiatal hernias are more common if you’re over 50
  • Pressure rises in your stomach - pregnancy, being overweight or obese, coughing, physical strain, lifting something heavy, or straining on the toilet.

Treatment for a hiatal hernia

Hiatal hernia treatment may include lifestyle changes, medication and surgery. You doctor will discuss the best treatment options for your hiatal hernia based on multiple factors such as your general health and anatomy, the extent and location of your hiatal hernia, and the severity of your symptoms.

Lifestyle modifications include changing your eating habits such as eating smaller and more frequent meals, losing weight and stopping smoking.

Over-the-counter or prescribed stronger medications may be recommended to manage your hiatal hernia symptoms.

Hiatal hernia surgery may be advised if other hernia treatments have not worked and you continue to experience severe reflux problems or if there's a risk of serious complications. Keyhole surgery is usually used for a hiatus hernia. This involves making small cuts in your abdomen. Hiatal hernia surgery involves:
  • Pulling your hiatal hernia back into your abdomen.
  • Mending the valve at the bottom of your oesophagus.
  • Closing the hole in your diaphragm muscle.

A laparoscopic Nissen fundoplication (LNF) is the standard procedures to repair a hiatal hernia. It permanently relieves your hiatal hernia symptoms. During laparoscopic Nissen fundoplication surgery, your surgeon wraps your upper stomach (called the fundus) around the lower part your oesophagus to create a permanently tight sphincter that prevents your stomach from moving back into your chest.

The operation is performed under general anaesthetic and lasts for up to 90 minutes.

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