Hiatal hernia takes place when the upper portion of the stomach pushes itself through an opening in the diaphragm, into the chest cavity. The diaphragm is a wall of thin muscles, which separates the chest cavity and the abdomen. In most cases, a small hiatal hernia doesn't cause problems and you may never know you have a hiatal hernia unless your doctor discovers it when checking for another condition.

But a large hiatal hernia can allow food and acid to back up into your oesophagus, leading to heartburn. Self-care measures or medications can usually relieve these symptoms, although a very large hiatal hernia sometimes requires surgery.

Causes

Hiatal hernia is primarily or most commonly caused due to the increase in pressure in the abdominal cavity. Sometimes, a lot of pressure may be felt around the stomach accompanied by coughing, vomiting, strain during bowel movements. For people born with an abnormal hiatus, the chance of getting hiatal hernia is more.

The two common types of hiatal hernia are:

 Sliding hiatal hernia, which occurs during the sliding out of the stomach and oesophagus into and out of the chest through the hiatus. This type of hiatal hernia is less intense and has no symptoms.
 Fixed hiatal hernia or paraoesophageal hernia is an uncommon type of hernia where a part of the stomach pushes through the diaphragm and stays there.

Symptoms

Usually, no symptoms are experienced during hiatal hernia. Some symptoms are experienced that happen due to stomach acids, bile or air, which enters the oesophagus. Some common symptoms include:

 Heartburns which become worse when a person lies down
 Chest pain, better called epigastric pain
 Problem in swallowing food
 Belching

Tests for diagnosis

Several tests can be carried out for the diagnosis of hiatal hernia. They include:

 Barium x-ray, where a person is made to drink a liquid filled with barium before the x-ray. The x-ray provides a clear image of the upper digestive tract region and the location of the stomach can be seen. If it is protruded out, hiatal hernia is signified.
 Endoscopy is another test for detection of hiatal hernia. A thin tube slides down the throat, which reaches up to the oesophagus and stomach. This will determine whether the stomach is pushing through the diaphragm or not.

Treatment

Medicines, which are used to cure a hiatal hernia may include antacids for neutralizing stomach acid, h2 receptor blockers to lower acid production and proton pump inhibitors. Sometimes fundoplication surgery is required for the treatment of hiatal hernia, although it is rare. Some common surgical techniques are rebuilding of oesophageal muscles or a surgery to put the stomach back in its actual place. Laparoscopic surgery methods are used. Hiatal hernia may reoccur even after surgery; so general precautions should be taken. You should:

 Exercise regularly and maintain a healthy weight
 Avoid lifting heavy objects and ask for help
 Avoid any kind of strain on the abdominal muscles

Hiatal hernia is a disorder, which is more common among people over the age of fifty. Necessary precautions and treatment should be adopted in case of hiatal hernia.


All About Hiatal Hernia

Laparoscopy surgery is a very vital component of the hernia repair. Studies have shown that many patients have a better outcome when they opt for laparoscopic surgery. Candidates eligible for this mode of surgery include those with bilateral inguinal hernias, ventral hernias, and recurrent hernia. People associated with athletics and other outdoor sports prefer to go for a laparoscopic hernia surgery as it ensures a speedy recovery and minimal tissue invasion (due to small incisions).

Laparoscopic hernia repair- inguinal
A laparoscopic surgery requires an incision of 1-2 cm at the belly (at the lower end). Two small punctures are done near the umbilicus. The punctures are done to make room for the cameras so that the surgeon is able to view the abdomen clearly. The smaller incisions allows the operating instrument to enter into the stomach.

The Procedure:
A balloon is placed in between the abdomen and the overlying muscle so that the peritoneum can be separated. When space is successfully made, the camera comes into the action to view the condition of a hernia. A hernia is pulled from its hole into the abdomen. Once the hole is detected, the defect of a hernia is fixed.

Laparoscopic hernia repair- incisional/ventral: Laparoscopic hernia repair is suitable for all types of a hernia such as an umbilical hernia, ventral hernia, recurrent umbilical hernia, epigastric hernia etc. Just like an inguinal hernia, A camera is placed into the abdomen through the muscles. Two small incisions are made for the operating instruments to get through. This is followed by the cutting of the tissue that is placed between a hernia and the intestine. The hole thus gets exposed. Through one of the laparoscopic ports, the hernia mesh gets rolled and is placed into the abdomen. A hernia is then pulled up and the mesh gets secured with 4 sutures. A special device is used to fix the healthy muscle.

Tension free repair: Tension free  repair is often used to symbolize hernia surgery. A hernia is often triggered by the weakened muscles. Few surgeons endeavors to sew the muscle around the area of a hernia. Since the muscles surrounding the hernia are weak in the first place, they pull apart causing a recurrence of a hernia. To avoid this, most surgeons use a mesh to strengthen the cells around the hernia region. This procedure ensures that the muscles aren t sewn but the mesh placed over the hole can prevent the muscle to push through the walls of the abdomen.

The use of mesh: There are some reservations about using the mesh in a hernia surgery. However, this is the safest and most appropriate way to perform a hernia laparoscopic surgery. The use of a mesh also negates the risk of open incisions and recurrence of a hernia.

Types of Hernia - How Laproscopy Can Help Manage?

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?

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, is not life threatening, but is commonly experienced by a number of people. You will experience hernia when an organ pushes through the muscles or tissues surrounding them. A hernia can occur anywhere in the body. The most common areas affected by it are the abdominal area, upper thigh, groin and belly button. In most cases, a surgery is required to treat this condition.

There are 4 common types of hernias. These are:

Inguinal hernia: This is the most common type of hernia and affects more men than women. It occurs when the intestines push through the lower abdominal wall into the inguinal canal.
Hiatal hernia:This commonly affects elderly people and occurs when the stomach pushes upwards through the diaphragm. It may also affect children if they are born with a congenital birth defect.
Umbilical hernia: This affects children and occurs when the intestine pushes through abdominal wall near the bellybutton.
Incisional hernia:This occurs after an abdominal surgery when the intestine pushes through the scar or other weak tissues.
A hernia can develop overnight or over a period of time. It can be triggered by many factors that cause weakening of muscles and strain the body.

Some of these are:

Congenital defects such as the abdominal wall failing to close properly
Age
Persistent coughing
Surgical errors or injuries
Pressure on the abdomen caused by pregnancy
Straining as a result of constipation
Collection of fluid in the abdomen
Heavy weight lifting
Excess weight gain
If anyone in your family has a hernia, you are at a high risk of suffering from one as well. Being obese and smoking can also increase your risk. Cystic fibrosis can also indirectly trigger a hernia by causing a persistent cough.Sometimes a hernia has no symptoms. A bulge in the affected area is the most common symptom of a hernia.

Some other symptoms that you may notice are:

Pain in the affected area
Weakness or pressure in the abdomen
A burning or aching sensation in the affected area
Acid reflux
Chest pain
Difficulty swallowing
If you wish to discuss about any specific problem, you can consult a doctor or ask a free question.

Things to know about Hernia

Hernia surgery is performed for the correction of a hernia which refers to the bulging of internal organs or tissues through an abnormal opening. It is easy to detect hernia through any pain or discomfort while lifting heavy objects, cough and strain during urination or bowel movements or during prolonged standing or sitting. It can be found in both men and women. The Hernia can be congenital or can be developed over a period of time. If it doesn t get better over time and also does not go away by itself, then surgery becomes the only option.

Types of Surgery
There are two types of surgery for hernia treatment. One is the conventional open method, which requires an incision in the skin directly over the hernia. The other one is the Laparoscopic hernia repair in which surgery is performed using a small telescope known as a laparoscope. In this type of surgery minimal invasions are made and the hernia is repaired with only small incisions adjacent to the hernia. Most hernia operations are performed on an outpatient basis, which means that you can go home the very same day.

Tips for early recovery

    Wear comfortable clothing with expandable waistbands.
    Keep yourself active by moving around as much as you can as it increases circulation, which further speeds up healing.
    Eat a diet rich in fibre, fresh fruits and vegetables.
    Drink lots of water and other fluids to avoid constipation.
    Do not lift any objects even if it is very light as it can bring back pain.
    Do not to pick up things from the floor as it will be difficult to bend.
    Hold a pillow against your stomach while sneezing or coughing to lessen the pain.
    Use stool softener for a few days before and after surgery to help you with your bowel movements.
    Avoid driving till the time you feel any pain and as long as you are taking narcotic pain medicines.
    Band-Aids which cover the incisions should be changed as and when needed.
    Refrain yourself from intercourse as it can be painful.
    Check with your doctor when to take a shower so as not to hurt your incisions, and make sure to gently dry your incisions and replace the Band-Aids after taking a shower.
    Do not consume any alcoholic drinks for at least 24 hours.

The tips mentioned above will definitely provide help to cope up with post surgery blues. However, in case of fever, excessive sweating, difficulty in urinating, bleeding or any prolonged pain consult your doctor immediately.

Hernia Surgery - 13 Tips to Help You Recover from it

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