The term 'hernia' refers to a protrusion of an organ or tissues from weak spots formed in the walls of the cavity that holds that organ. Hiatal hernia is a type of hernia wherein a part of the upper stomach protrudes through the hiatal opening into the thoracic cavity. Hiatal opening, which is also known as esophageal hiatus, is a small opening in the diaphragm. The esophagus or the food pipe passes through this opening in the diaphragm so as to connect to the stomach in the abdominal cavity.
Under normal circumstances, the esophageal hiatus is large enough just to allow the esophagus and a few nerves or blood vessels to pass through. If this opening is larger than its usual size, then the stomach could bulge from this opening towards the chest. Under such circumstances, a hiatal hernia surgery may need to be performed so as to push the herniated stomach back to its place.
Causes and Symptoms of Hiatal Hernia
Hiatal hernia may occur if the size of the esophageal hiatus is larger than its usual size. Acid reflux disease is a medical condition that may also make one susceptible to this hernia. Acid reflux disease is characterized by the regurgitation or the backflow of gastric juices from the stomach into the esophagus.
This may be caused owing to a weakened lower esophageal sphincter valve that aids in pushing food into the stomach. This valve may become weak due to consumption of acidic foods. This condition could also occur if the diaphragm gets weakened due to frequent strain during bowel movements. Thus, chronic constipation surely puts one at an increased risk of developing this condition.
Chronic violent coughing can also weaken the diaphragm. Stomach may also protrude if the esophagus is not firmly attached to the diaphragm. A person suffering from this type of hernia is most likely to experience symptoms such as difficulty in swallowing food, burning sensation in the chest, regurgitation of stomach acid, acid taste in mouth, belching, chest pain or tightness in the chest. The symptoms may worsen after having meals. If the portion of the stomach that is herniated gets strangulated and the blood supply to it gets cut off, serious complications could arise. Under such circumstances, hernia repair surgery may become an absolute necessity.
Surgical Treatment of Hiatal Hernia
Though surgery is not resorted to always, if the symptoms are severe, doctors may ask the patient to undergo a surgery. Hernia surgery is classified into open surgery and laparoscopic surgery. Both of these are performed under general anesthesia. In case of an open surgery, a single incision would be made into the chest wall or the abdomen in order to push back the herniated stomach. This is followed by reducing the size of the hiatal opening.
The esophageal sphincter muscle may also be reconstructed. The upper portion of the stomach would then be wrapped around the lower section of the esophagus and stitched back in its place. This is to prevent back flow of acid. The incision would then be closed with sutures. At times, a tube is placed inside the stomach in order to prevent the stomach shift from its place. This may be removed after the patient shows signs of recovery.
In case of a laparoscopic surgery, small incisions are made around the herniated section. A laparoscope is inserted through one of the incisions. Since a mini-camera is attached to the laparoscope, the image of the internal organs can be seen on the video monitor. The images guide the surgeons as they insert surgical instruments through smaller incisions and push back the stomach into place. Once hernia is repaired, the incisions are sutured. One may recover from the surgery within a month.
Generally, antibiotics are prescribed so as to lower the risk of infection. Constipation must be avoided as straining during bowel movements can stress out the abdominal muscles. One must therefore, have smaller but frequent meals. One must also increase one's fluid intake. Following the dietary guidelines post surgery is extremely important to prevent the recurrence of hernia or any other complications.
Those who have been experiencing the aforementioned symptoms, must consult a doctor immediately. If left untreated, one would not only experience severe discomfort, but also be at a risk of developing complications. Strangulated hiatal hernia is a life-threatening complication that must be averted at all costs. The earlier this condition is diagnosed and treated, the better would be one's chances of recovery.