A hiatus hernia is a condition where part or all of the stomach (and or other organs) moves from the abdominal area into the chest. The stomach is usually located in the abdominal cavity below the diaphragm (a layer of muscle that separates the organs in the chest from the abdomen). The food tube also known as the oesophagus enters the abdomen through a hole in the diaphragm. In patients with a hiatus hernia the stomach pushes up into the chest through this hole.
Sliding hiatus hernia is where the lower oesophagus and the stomach slide above the diaphragm into the chest. This is the commonest type of hernia.
Paraoesophageal hiatus hernia occurs when the upper part of the stomach (and sometimes other organs) pushes into the space above the diaphragm next to the stomach. This is less common but can be more life threatening as this can cause the blood supply to the stomach to become affected, can result in bleeding or difficultly breathing
The exact cause of a hiatus hernia is not clear. The risk factors include:
In many instances a hiatus hernia does not cause any symptoms. In other cases patients can experience symptoms related to the leakage of acid from the stomach into the oesophagus, also known as reflux.
This can result in :
Some unusual symptoms of a hiatus hernia include:
A hiatus hernia is usually diagnosed when patients investigated for their symptoms. It can be identified on an x-ray of the chest. It is frequently diagnosed when an endoscopy (flexible telescope test) is performed to visualize the inside of the oesophagus and the stomach. Other tests may include a barium swallow; when the patient is asked to swallow a dye and a series of x-rays are performed and manometry; when a tube in the oesophagus is used to measure oesophageal pressures.
By not undergoing surgery patients can experiences complications from a hiatus hernia including:
When conservative measures fail an operation may be advised to treat a hiatus hernia. During surgery the stomach (and/or other organs) are pulled back into the abdomen and the weakened diaphragm around the oesophagus is tightened. This is usually done with sutures but occasionally a mesh may be used to strengthen the muscle. Following this the oesophageal sphincter muscle is strengthened by wrapping the upper stomach around the lower oesophagus (fundoplication). This helps with symptoms or reflux in particular.
The operation is performed under a general anaesthetic. It may be performed using a thin camera inserted into multiple small abdominal incisions (laparoscopic) or may be performed using a bigger cut in the abdomen (laparotomy) and very occasionally in the chest wall (thoracotomy)
The risks of surgery include:
How long will I be in hospital and what is the recovery period and follow up?
After surgery the course of recovery is as follows:
