• The hiatus is an opening in the diaphragm - (the muscular wall separating the chest cavity from the abdomen). Normally, the oesophagus (food pipe) goes through the hiatus and attaches to the stomach.
What is Hiatus Hernia?
• In a Hiatal Hernia (also called hiatus hernia) the stomach bulges up into the chest through that opening in the diaphragm.
• In a Sliding Hiatal Hernia, the stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. This is the more common type of hernia.
Paraesophageal Hernia - next to the oesophagus
• The paraesophageal hernia is less common, but is more cause for concern. The oesophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the oesophagus.
• Although you can have this type of hernia without any symptoms, the danger is that the stomach can become "strangled," or have its blood supply shut off.
What is GERD?
• GERD - Gastro Esophageal Reflux Disease
• Many people with hiatal hernia have no symptoms, but others may have heartburn related to gastroesophageal reflux disease, or GERD.
• Although there appears to be a link, one condition does not seem to cause the other, because many people have a hiatal hernia without having GERD, and others have GERD without having a hiatal hernia.
• People with heartburn may experience chest pain that can easily be confused with the pain of a heart attack. That's why it's so important to undergo testing and get properly diagnosed.
• Barret’s Esophagus
Note : Chances of complications are higher with Paraesophageal hernia
• Most of time not known
• A person may be born with a larger hiatal opening
• Increased pressure in the abdomen such as from pregnancy, obesity, coughing, or straining during bowel
• Age > 50
• X-ray (using a barium swallow) oesophagus
• 24 Hours PH Study
• Esophageal Menometry
Medical treatment - mainly medicines for acidity.
Surgery - Preferably Laparoscopy (Closure of Crura (with/without mesh) +Fundoplication).
Note:Other symptoms that may occur along with the hernia such as chest pain should be properly evaluated. Symptoms of GERD, such as heartburn, should be treated.
When is Hiatal Hernia Surgery necessary?
• Patient is already suffering from the complications
• Patient is at high risk of complications
• The Paraesophageal hernia