What do we mean by a hiatal hernia?

The hiatus is an opening in the diaphragm (the muscular wall) which separates the chest cavity from the abdomen. Normally, the esophagus (food pipe) goes through the hiatus and attaches to the stomach. In a hiatal hernia, the stomach bulges up into the chest through that opening.

What does statistical data say about a hiatal hernia?

Statistically, approximately 60% of individuals who are above age 50 or older have a hiatal hernia.

In which age group is hiatal hernia very common?

The incidence of hiatal hernias increases with age. It is commonly seen in the older age people specifically in people who are above 50. 

What are the causes of hiatal hernia?

The most common risk factors are as follows: 

Obesity Congenital deformities, such as scoliosis
Certain types of surgery
Major trauma
Conditions which causes an increase in abdominal pressure within the abdomen, such as heavy lifting, or bending over, frequent or violent coughing, violent sneezing, violent vomiting, and straining during bowel movements
What are the types of a hiatal hernia?

There are four types of a hiatal hernia and they are as follows:

Sliding hiatal hernia: This is the most common variant of a hiatal hernia. It occurs when your stomach and esophagus slide into and out of your chest through the hiatus. It is usually asymptomatic.
Fixed hiatal hernia: It is also known as a paraesophageal hernia. In a fixed hernia, part of the stomach pushes through diaphragm and stays there.
Type III hiatal hernia: In this type, as a hernia goes on increasing, the phrenoesophageal ligament stretches and displaces the gastroesophageal junction above the diaphragm
Type IV hiatal hernia: Type IV hiatal hernia includes a large defect in the phrenoesophageal ligament causing other organs, such as colon, spleen, pancreas and small intestine to enter the hernia sac.
What are the sign and symptoms of hiatal hernia?

Common symptoms include:

Heartburn
Chest pain or epigastric pain, coughing
Difficulty in swallowing
Belching, eructation, and hiccups
How to diagnose the condition?

To diagnose this condition following tests or procedures are included:

X-ray of the chest and abdomen Barium follow-through examination of gastrointestinal tract (GI) to visualize GI tract.
Upper endoscopy for examining the esophagus and stomach from inside Esophageal manometry for measuring the rhythmic muscular contractions of esophagus while swallowing, and also, measuring the force exerted by the muscles of esophagus.
What is the treatment available for it?

It includes medications and surgery which are as follows:

Antacids to neutralize stomach acid and to reduce acid production
Medications that heal the esophagus 
Surgery of opening of diaphragm to make it smaller and for reconstruction of an esophageal sphincter

Hiatal Hernia - How Is it Diagnosed?

A Hernia may be defined as the protrusion of an organ into an adjacent connective tissue or muscle. The protrusion usually occurs through a tear or a weakened area in the muscle (Fascia). Hernia can be an Inguinal Hernia, Umbilical Hernia, Hiatal Hernia or Femoral Hernia. It can also originate from an incision (Incisional Hernia).

The Inguinal Hernia is commonly observed in males. Here, the intestine squeezes through a tear in the abdominal wall into the groin (Inguinal canal). At times, the small intestine bulges through the abdominal wall (weak spot) near the belly button, which results in Umbilical Hernia. In Hiatal Hernia, the upper part of the stomach passes into the chest through the diaphragm, and of all the hernia types, the Inguinal Hernia is the most common.

Severe strain and muscle tear or weakness can result in Hernia. Obesity, chronic constipation, chronic coughing and sneezing, ageing, damage caused by injury, medical conditions like Cystic Fibrosis, contribute to increased incidences of Hernia. In case of Hernia, the affected area tends to protrude or bulge out. If left untreated; Hernia can prove to be detrimental. One needs to consult a physician for proper diagnosis and treatment. Physical examination can help in the diagnosis of Inguinal Hernia. An ultrasound is needed to diagnose Umbilical Hernia. A Barium X -ray or endoscopy can be of great help in the diagnosis of Hiatal Hernia.

The severity of the Hernia depends upon its size. In case the Hernia is rapidly increasing in size, a surgery is needed for the repair. The surgery performed can be open or laparoscopic. In open surgery, Hernia is identified through an incision. Once located, the Hernia is removed from the adjacent tissues. In laparoscopic repair, small incisions are made in the affected region. Through these incisions, specialized instruments are inserted. It is through these instruments that the surgeon visualizes and performs the surgery.

In such repairs, a mesh, held in place by sutures is used as a scaffold. This facilitates the growth of new tissues in the affected person. This technique significantly lowers the chance of a recurrence. Certain factors must be well addressed, before performing a Hernia operation:

* Hernia operations, laparoscopic in particular, should be performed by experienced surgeons. Inexperienced surgeons will do you more harm than good.
* Laparoscopic Hernia operation should be avoided in case a patient has adhesions from previous surgery.
* Extreme care should be taken while performing a Hernia operation in infants and children.
* In some cases, Hernia surgery might affect or injure the vas deferens in men. This in turn can affect fertility in men.

What To Know About Hernia Operation

What is a hernia?

The presence of weakness or hole in a muscle, which permits tissues and organs to bulge through the defect, is termed as a hernia. Hernias can range from harmless or barely noticeable to life-threatening, depending on the organs involved and size of a hernia. In such cases, a surgeon to counter the presence of a hernia performs a hernia repair surgery. Otherwise, it might cause substantial organ damage.

How many types of hernias are there?

A hernia can occur in any part of your body. However, it is most commonly found in the groin and stomach region. Apart from that, listed below are the different types of a hernia-

  An incisional hernia- Occurs around the incision site, due to surgery
  An umbilical hernia- Occurs close to the belly button or umbilicus
  Congenital Diaphragmatic hernia (CDH)- Occurs during birth, that might cause the internal organs to move into the chest cavity
  An inguinal hernia- Occurs in the groin region, similar to a femoral hernia
  An epigastric hernia- Occurs between the chest and belly button
  A femoral hernia- Occurs in the groin region, like an inguinal hernia
  A hiatal hernia- A hiatal hernia can cause the stomach to move into the chest cavity

A hernia can cause many problems for you, not just physically but also from other aspects as well. If you do not go for treatment at the right time, it can interfere with your day-to-day activities due to the serious pain associated with it.

What are the factors or signs that call for a hernia repair surgery?

Hernias can sometimes take a long time to notice. Many people notice the presence of a hernia when they participate in any kind of physically taxing or strenuous work. The following symptoms will help you understand whether you need a hernia repair surgery-

  Discomfort or pain that intervenes with your daily activities
  Large-sized hernias
  If your hernia is gradually growing in size and getting worse, especially in the groin region
  When your hernia starts putting a lot of pressure on your nerves, which lead to numbness and irritation
  Long-term discomfort caused due to a hernia
  Vomiting and a piercing stomach pain

The process of performing a hernia repair surgery

Hernia surgery is done in the following two ways-

  Laparoscopic surgery - During this procedure, the surgeon will inflate your stomach with harmless gas, to have a clear look inside. After this, he will make small incisions near a hernia and put a thin tube with a minute camera. This will give him get a clear view inside your stomach and allow him to repair a hernia with a mesh.

  Open surgery - In this procedure, the surgeon will make a large incision and open up your skin. After this, he will slowly push a hernia back inside, tie it and then remove it. Once this is done, the incised site will be closed up with stitches. In case the hernia is considerably large, the surgeon will use some extra mesh, to keep a hernia in its place.

Medical advancements have made it possible and quite easy to perform hernia repair surgeries, with minimal pain. Hence, if you notice even a faint sign of a hernia, make sure that you consult a doctor and get the right treatment.

Hernia Repair Surgery - What Should You Know?

Hernia refers to the condition when an organ or fatty tissue inside the body begins to protrude from its location. Hernias are mostly detected in the groin, belly, or the stomach region. They occur because of muscle weakness in the said region where it is detected but they can be treated with surgery. In most cases, a surgery is prescribed and laparoscopic hernia repair is a very popular surgical procedure that has proven to be successful in most of the cases. This is why a growing number of patients decide to go for it.

Laparoscopic hernia repair: procedure: In this surgical procedure, a laparoscope (an instrument with a high-resolution camera and high-intensity light) is passed inside the abdomen through small incisions that varies between 0.5 and 1.5 inches in length. When the laparoscope moves inside the abdomen, it sheds light on the hernia and sends the images to the monitor connected to it. The surgeon views the hernia on the monitor and then the abdominal cavity is made to swell with carbon dioxide so that the surgeon can find enough space to operate the hernia. Once this is done, the surgeons operate the hernia with tiny surgical instruments. Once the hernia is removed, space or the hole is covered with a mesh from inside the abdomen.

Advantages of laparoscopic hernia repair: The laparoscopic procedure is popular because it is comfortable for the patient in many ways. They have to endure lesser post-operative pain as compared to open surgery, which means the recovery is quicker. They require lesser drugs for healing and the patient can get back to work in fewer days. It is an advanced form of surgery and thus, gives better results.

Disadvantages of laparoscopic hernia repair: While the non-invasive laparoscopic surgery has several advantages, it also comes with some drawbacks. It is lengthier in comparison to open surgery and also costs more. It cannot be performed by all the surgeons and only those who are skilled in this type of surgery can do justice to the different cases of a hernia. 

Recovery after laparoscopic hernia repair: The patient takes one to two weeks after the surgery to return to light activity and daily routine. Nevertheless, heavy exercise and strenuous activity should be avoided until four weeks after the surgery. The full recovery time differs from patient to patient depending on their age, gender, and health condition but one month is the average time for full recovery.

555 Manish Technique for inguinal hernia repair:

Totally extra-peritoneal (TEP) repair of inguinal hernia is now a standard surgical technique. A 12 mm incision in infra-umbilical region for Hasson trocar is must for TEP repair of inguinal hernia. This is the only technique known to laparoscopic surgeons. We have innovated a "555 Technique" for completing Mini TEP repair of inguinal hernia by using all three 5 mm ports.

555 Technique" is a feasible option without compromising the principles of TEP repair for inguinal hernia. Innovation of simple "Manish Retractor" is the key in completing Mini TEP repair. This technique is simple, less invasive, less morbid, and cost effective as it avoids dependence over costly Hasson trocar with better cosmetic results.

Laparoscopic Hernia Repair - What Should You Know

Anti-reflux surgery (Fundoplication) is a procedure for treating gastroesophageal reflux disease (GERD) incorporated in hiatus hernia operation. GERD occurs when stomach contents reflux and enter the lower end of the esophagus (LES) due to a relaxed or weakened sphincter or a hiatus hernia. GERD is very much treatable and can cause serious complications if left untreated. 

GERD symptoms
The main symptom of GERD is heartburn or indigestion, along with other symptoms, such as 

Acidic sour taste in the mouth
Burning pain in the throat
Difficulty in eating
Bloating and belching
Stomach pains
Regurgitating food
Nausea
Vomiting blood
Dark tarry stools
Laparoscopic Anti-Reflux Surgery
Laparoscopic surgery reinforces the lower oesophageal sphincter s ability to prevent gastroesophageal reflux from occurring. The surgery involves wrapping the top part of the stomach around the lower end of the esophagus and suturing it in place. Since the esophagus passes through the hiatus, suturing is done to narrow the hiatus as it helps in the prevention and treatment of concurrent hiatal hernia.

Laparoscopic Surgery Procedure
A laparoscope, a long, narrow telescope with a light source and a video camera at the end, is inserted through a tiny incision into the abdomen. Images from the camera are projected onto a large high definition monitor for the surgeon to view enlarged images as it helps the surgeon perform surgery with precision.

The patient is placed under general anesthesia
The surgeon makes a small incision in the upper abdomen and inserts the laparoscope into the abdomen.
The surgeon introduces carbon dioxide into the abdominal cavity near the belly button to expand the viewing area of the abdomen giving the surgeon a clear view and room to work.
Additional small incisions are made for a variety of surgical instruments to be used during the procedure.
After the identification of critical structure, the hole in the diaphragm, through which the esophagus passes, is then tightened with sutures.
The surgeon wraps the upper part of the stomach around the lower esophagus guided by the images on the laparoscope, then creates a valve which is precisely sutured in its place.
The laparoscope and other instruments are removed and the gas is released.
The tiny incisions are closed and covered with waterproof dressings to avoid any kind of infections.
The patient is usually discharged within 1-2 days of the surgery.
Post-surgery, hospitalization is required just for one day - no bed rest is required after that. The patient can quickly return to all normal activities and immediate relief from symptoms also happen. 

Laparoscopic Surgery - How It Can Help With Anti-Reflux and Hernia?

An inguinal hernia refers to the condition when tissues, such as those which are a part of your intestines, find a weak spot in your abdominal muscles and protrudes outwards. This may often result in a painful bulge, especially at times when you bend over, lift heavy objects or cough.

Usually, if the hernia is small, your doctor might just ask you to wait and leave it untouched. In children, manual pressure may also be applied to reduce bulging. Enlarged or very painful hernias, however, require surgery for the prevention of complications and for relieving discomfort.

Generally, there are two types of hernia repair surgeries which are as follows:

1. Open hernia repair surgery: This type of surgery is carried under sedation by local anaesthesia, and ensures an incision being made in the groin to push back the protruding tissues into the abdomen. The weakened area is then sewn back, and reinforced with the help of a synthetic mesh, a procedure called hernioplasty. The opening is then closed down using staples, surgical glue or stitches. Though movement as soon as possible is recommended, exertion must be avoided.

2. Laparoscopy: This is a kind of minimally invasive surgery, done with the aid of local anaesthesia. In this procedure, multiple small incisions are made in the abdominal region and then gas is used in order to inflate it, to make visibility easier.

A tiny camera is attached at the end of a small tube (a laparoscope) and then inserted into the cavity created by the incision. With the aid of the increased visibility facilitated by the camera, the surgeon then inserts other tiny instruments through the remaining incisions for repairing the hernia, with the help of a small synthetic mesh.

This kind of surgery allows your surgeon to avoid the scar tissue which might be present from a hernia and which might have been repaired earlier. Laparoscopy is thus also recommended for those with bilateral hernias (on both the sides).

However, research has shown that this kind of repairing may also increase the likelihood of recurrence or some other complications or risks.
Risks are usually reduced when the surgery is performed by a surgeon who has a lot of prior experience in the same.

Inguinal Hernia Treatment

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