Hiatal Hernia

What Is A Hiatal Hernia?

Many factors can contribute to hiatal hernia formation. The hiatus is a muscle and any condition that affects the muscle in any way can increase the chances of developing a hiatal hernia. Many of the risk factors below can increase the chances of other hernias.

• Sex: Female patients are four times more likely to develop hiatal hernias than the male counterpart.
• Age: Muscle mass decreases with age and the incidence of hiatal hernias increases exponentially with age.
• Genetics: If some of your close family members have developed hiatal hernias you have a higher risk of developing one.
• Trauma: Patients with a history of significant blunt trauma have a higher risk due to increased intra-abdominal pressure during the accident. 
• Congenital: Hiatal or diaphragmatic hernias are rare in the pediatric population but when present they can be severe. 
• Obesity: Increase intra-abdominal pressure due to obesity is a significant risk factor.
• Smoking or chronic respiratory conditions: Coughing is one of the things that increases intra-abdoimal pressure the most and subsequently increasing the risk of hernias. 
• Heavy lifting: Occupations, sports or hobbies that require significant lifting are associated with an increased risk for hiatal hernias. 

Most patients with a hiatal hernia have no symptoms. This is particularly true for smaller hernias. Usually, as the hernia enlarges symptoms start to appear. Below you can see some of the most common symptoms.

• Heartburn or reflux
• Regurgitation
• Difficulty swallowing
• Upper abdominal or chest pain
• Shortness of breath
• Anemia from slow bleeding Cameron ulcers
• Low appetite or getting full quicker
• Bloating or indigestion

Most hiatal hernias are found incidentally in patients that undergo studies for other conditions. In patients that present with some or several of the above symptoms, the physician will get other diagnostic studies.

The most common and least invasive diagnostic study is either an Upper GI Series or a CT scan. Both radiographic studies have good sensitivity in visualizing a hiatal hernia. This is particularly true in larger hernias.  The upper GI series is the test of choice because it will also give the physician other valuable information. The study can diagnose esophageal reflux in combination with the hernia. It will also evaluate the swallowing mechanism as the test is done in real time while the patient is swallowing the contrast.

Upper endoscopy or EGD is the next test of choice. This is more invasive and it requires mild anesthesia. The study can diagnose hiatal hernias but also can show ulcers, inflammation, strictures, polyps and other conditions of the upper GI tract. 

Because the operation is done minimally invasive the patient will experience less pain, faster recovery and faster return to regular activities.

After surgery, you will be in the recovery room for 2-3 hours. Hospital admission for 1-2 days or discharge home on the same day of surgery will depend on several factors. Your overall medical condition and how you did during surgery is the first factor. The other main factor is the antireflux component like we explained above (Linx vs Nissen Fundoplication).

After a Linx procedure, you will be discharged home the same day of surgery with several days supply of pain medication. You will stop the antireflux medications immediately after surgery. Patients are encouraged to eat normal food right away to prevent stiffness of the device. Some discomfort is expected after swallowing, this will resolve spontaneously with time.

After a Nissen Fundoplication, most patients will be admitted to the hospital for 24-48 hours. They will be started on a clear liquid diet on day one and a full liquid diet on day two. Patients are required to stay on a full liquid diet for 2 weeks. The diet is advanced to a soft diet for two more weeks after that.

You will follow up with Dr. Caban in 2-3 weeks and at 3 months after surgery.

Most patients that have office type job can expect to return to work after 1-2 weeks. For those of you that have a heavy labor job were heavy lifting more than 15-20 pounds is necessary, you should account for 4-6 weeks out of work.