A hernia can be simply described as a bulge or an out-pouching of body contents into an area outside their normal positions. They can happen anywhere in the body although the trunk is the most commonly involved region. Our center, Chennai Hernia Center has experts well versed in the diagnosis and treatment of all types of hernias.
What is a hiatal hernia?
A hiatal hernia is a special type of hernia that occurs when part of the stomach is pushed up into the chest through an opening in the large muscle (the diaphragm) that separates the stomach and the lungs. This opening called the hiatus is how the food pipe (esophagus) connects to the stomach, thus leading to the name hiatal hernia. There are two types of hiatal hernia- sliding and rolling hernias:
Sliding hernia: This type is most common and may show mild symptoms or no symptoms even. Here, the food pipe and stomach together move up through the hiatus into the chest, or rather, they “slide up” smoothly together. These hernias might have symptoms on and off because the hernia might slide back down from time to time.
Rolling hernia: Although less common, these are more dangerous than the other type. In this type of hiatal hernia; the esophagus is not shifted from its position but a part of the stomach slides up through the hiatus by squeezing through the side of the esophagus. Since this is an extremely small gap, the hernia can get stuck there and cause complications.
How do I know if I have a hiatal hernia?
Many people with a hiatal hernia often have no symptoms and may not realise it even exists! Out of the symptoms that can manifest, heartburn is the most common one. This is because the acid that is produced in the stomach and stays there can flow upward into the esophagus due to the improper movement of the hernia.
Since the esophagus is not built to withstand the effects of acid like the stomach, it can lead to symptoms of acid reflux like heartburn, bloating, belching, difficulty swallowing, nausea etc. If this continues for a long time, longstanding acid reflux symptoms like persistent cough, sore throat, bad breath, recurrent chest pain and dental issues can also happen.
The most serious symptom is when a rolling hernia gets stuck with its blood supply cut off (“strangulated”) leading to severe pain in the chest or abdomen, loss of defecation or flatulence, nausea, vomiting with a rapid decrease of physical wellness (as the patient goes into “shock”). This is a medical emergency and requires immediate intervention.
Why do hiatal hernias occur?
There are no specific reasons for their occurrence. Sometimes, people are born with a bigger hiatus than normal; sometimes the diaphragm loosens as we age leading to a widening of the gap. In some people, body changes that put some stress on the diaphragm like obesity and pregnancy can also lead to hiatal hernias. Previous injury to the area or history of diaphragmatic or upper gastrointestinal surgery have also been implicated in their formation. In very rare cases, some babies are born with diaphragmatic hernias.
I have severe heartburn! Could it be a hiatal hernia?
Heartburn is a symptom of hiatal hernias but not exclusive to it. If you suffer from severe heartburn, it is best to seek medical attention. A hiatus hernia cannot be diagnosed solely on the basis of symptoms and alone. At our center, Dr. Rengan will carefully consider your symptoms, do a physical examination and perform tests in order to reach the correct diagnosis. Some tests that can be done to diagnose a hiatal hernia are :
A special X-Ray called a Barium swallow
Endoscopy in which a thin tube with a camera at the tip is passed down into your food tube in order to visualise the area.
Esophageal manometry, in which another type of tube is passed into the food tube to measure the pressure at the area.
At Chennai Hernia Center, we pride ourselves on not performing unnecessary procedures and keeping a patient-centric approach, so we will only prescribe tests and treatments we deem necessary. For mild heartburn or asymptomatic non-risky hernias, we will not push for unnecessary invasive treatment.
What are the treatment options for hiatal hernia? Is surgery always needed?
If your hiatal hernia has not caused any symptoms or problems, we can approach it in a “wait & watch” manner, with regular review checkups. For very mild cases of heartburn, a trial of acid reflux treatment with medicines can be given. However, if the symptoms are recurrent, if there have been gross pathological changes like ulceration or thinning of the affected area, or if the hernia seems at risk of strangulation; surgery will be recommended to you. Since recurrent acid reflux carries with it a risk of esophageal cancer and since a strangulated hernia can cause life threatening complications, both of these are scenarios that are best treated preemptively.
What surgery will be done for me? Is it going to leave me bedridden for weeks?
The surgeries done to treat hiatal hernias can be open surgery or laparoscopic (key-hole) surgery.
The basic aim of the surgery is to push back your stomach to its original position, tighten the diaphragm so that the hernia cannot recur and also replicate the valve between the food pipe and the stomach so that reflux cannot recur.
Laparoscopic surgery is now the most commonly used method in which multiple small incisions are made in the area in order to pass some thin devices through. These devices can be used to visualize the area and manipulate the organs and tissue to perform the required reparations. The devices are then removed and the incisions are sown up with minimal blood loss. While laparoscopic surgeries are usually more time-consuming for the surgeon, they provide the benefits of quicker recovery and less complications for the patient. However, this type of surgery is not performed for massive defects or emergencies because it can lead to poor results.
Open surgery is the traditional model of surgery where a large incision is made in order to reach in and perform the repair. This is usually the option of choice for large defects and emergencies and usually requires a longer stay than key-hole surgery. Sometimes, a tube will have to be left in after the surgery.
Both types of surgery are done under general anesthesia and may only require admission for a couple of days depending on your other medical factors.
Dr. Rengan and all his associates are experienced and familiar with both types of surgery. At our center, we will have a detailed discussion with you where we figure out the best type of surgery for you. Once the decision for surgery has been made, further pre-operative discussions will be held to further evaluate your personal and physical condition.
Although rest is advised post-operatively, you will not be bedridden at all. In fact, we encourage movement as soon as you are comfortable. Our team at Chennai Hernia Center will give you the correct advice and instructions on how to take care of yourself after the surgery. We will provide detailed instructions and medicines for pain relief, wound care, diet and physical exercise after the surgery. We will schedule review sessions with you even after healing so that you can be informed on what other diet & lifestyle changes you can make in order to prevent a recurrence or further complications.
Chennai Hernia Centre is an initiative by our Chief Surgeon Dr ( Major ) R S Rengan to create a hernia focussed clinic to ensure high standards of care without compromising on affordability in the field of hernia surgery.