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Hiatal hernia: everything you need to know

A hiatal hernia occurs mainly in people over 50.

What is a hiatal hernia, and how can it be treated?

hiatal hernia, also known as a hiatus hernia, happens when a section of your stomach squeezes into your chest through an opening in your diagram. This opening in your diagram (a large sheet of muscle between your chest and tummy) is referred to as a hiatus. We investigate the two main types of hiatal hernias, their causes, symptoms and available treatment options. 

There are two types of hiatal hernias:

Sliding hiatal hernias slide in and out of a hole in the diaphragm which connects with the oesophagus. They slide in and out whenever there is swallowing, as the muscles pull and push the stomach out of the cavity above the diaphragm. These do not tend to cause serious symptoms and can be treated with over-the-counter Proton Pump Inhibitors.

Rolling/Giant (or para-oesophageal) hiatal hernias push out of the membrane between the oesophagus and the diaphragm. These occur in only 10% of hiatal hernia cases, but can be related to the sliding hernias. The fattier, larger side of the stomach is more susceptible to the movements of the muscles around the oesophagus.

These movements may cause the stomach to be pulled all the up and through the diaphragm, which requires immediate surgery.

Individuals are most at risk of hiatal hernias if they are obese, as this causes strain on the diaphragm due to the excess weight that your body struggles to deal with.

Other risks include age, as the structural integrity of the diaphragm degrades as you age, meaning you are more prone to a wider hiatus.

Congenital underdevelopment of the hiatus and general diaphragm also predisposes individuals to developing a hiatal hernia.

Individuals are also at risk of developing a hiatal hernia if they undertake heavy lifting or have pressure exerted on the oesophagus from regular vomiting, chronic heavy coughing, and excessive exercise. 

All of these cause damage to the diaphragm and the can cause a wider opening of the hiatus.

A hiatal hernia has different symptoms, primarily related to the activity of the stomach.

Individuals with a hiatal hernia tend to experience acid reflux, heartburn (which can get worse when you sit or lie down, as the stomach moves), gaseousness, pain in the left side of the ribcage, difficulty swallowing food or spittle, and trouble swallowing.

Individuals with hiatal hernias often also have gastroesophageal reflux disease (GERD), which a severe development of acid reflux.

This can be highly uncomfortable, and makes treatment for a hiatal hernia all the more pressing.

A hiatal hernia can generally have its symptoms treated by antacids and anti-acid reflux treatments (Proton Pump Inhibitors), as well as treatments that reduce stomach acid production and create a healthy environment for your oesophagus to heal.

The only way to reverse a hiatal hernia is through hernia repair surgery. However, this is not always necessary and should only be done in the case of the hernia becoming dangerous or the symptoms being irreducible.

Primarily, surgery is reserved for the rolling hernia if it is symptomatic or poses a risk of strangulation, which can often be sudden and fatal. A rolling hernia treated by surgery, either in open surgery or with key-hole surgery (laparoscopically). Generally, surgeons prefer key-hole surgery as it is quicker, less invasive, and means you can recover quicker. The time between diagnosis and private hernia surgery is often less than a month, ensuring you receive rapid and world-class treatment.

Laparoscopic surgery for hiatal hernias

Our laparoscopic surgery requires a few small incisions around the incisional hernia using a machine controlled by experienced and highly skilled clinicians. You will be placed under general anaesthetic for the procedure. The stomach will be stapled to the inner abdominal wall or wrapped around the lower oesophagus, which will stop it from coming up and popping through the diaphragm.

Sometimes, your surgeon may choose to close your hiatus (the hole in the diaphragm for your oesophagus) in order to better prevent strangulation.

A consultation with an experienced Consultant is often the quickest and simplest way to diagnose and treat your hernia.

They will be able to talk with you about the best treatment options for your specific situation.

Book an appointment online today.

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