Hernia is the name given to the condition where an internal part of your body pushes itself into another area of the body where it does not belong. A hiatal is the opening in the muscular wall which is called the diaphragm. This usually separates the abdomen from the chest cavity. In the human body, the food pipe, which is called the esophagus passes through this hiatal and joins the stomach area. Hiatal hernia is a condition when the stomach bulges up through this opening, into the chest.

Causes of Hiatal Hernia:
The main cause of hiatal hernia is not known at present, but there are certain factors that can cause it. It could occur when there is an increased pressure on the abdomen area such as during a pregnancy, coughing, obesity, too much straining at the time of bowel movement. Some people are also born with a wide hiatal opening.

Who needs surgical treatment for Hiatal Hernia?
In most of the cases, hiatal hernia does not show any kind of serious signs and hence you need not have to worry about it, When you experience symptoms such as acid reflux, gastroesophageal reflux disorder or heartburn, then you can treat them with mild medication and with the help of your doctor. But when the symptoms are severe and interferes with the quality of your life, or if the symptoms are not responding to medication, when the blood flow to the herniated tissue is blocked, causes ulcers, or heavy bleeding, you will need a surgery.

There are three types of surgeries for hiatal hernia.

Nissen Fundoplication: This is the most common surgery done for hiatal hernia. This is also called keyhole surgery or laparoscopic surgery. Small incisions are made in the abdomen area and the hernia is repaired. The surgeon also tightens the stomach in order to avoid the reoccurrence of this condition. It is a less painful and minimal scar process. Recovery time is also less compared to other surgical techniques and you also need not have to stay for a long period in the hospital.
Open repairs: For the repair of the hernia, a large incision is made in the abdomen area. The stomach is pulled back to its original place from the chest area. A small tube is also inserted in certain cases in order to keep the stomach in its original place and prevent it from moving towards the chest area. This kind of surgery has a lot of risks.
Endoluminal Fundoplication: This is the latest surgery technique and rarely used. No incisions are made in this procedure. Only a tube and camera are passed through the throat. The stomach is tightened and acid reflux is prevented.

Hiatal Hernia - 3 Types Of Surgeries That Are Often Recommended!

A hernia occurs because of an internal weakening of the abdominal layer, resulting in tearing. The inner most layer of the abdomen forms a sac and pushes the weakening area. This results in the abdomen tissue being slipped into the sac, causing pain and other health problems. It can occur to both men and women. Apart from natural weakness of the abdomen, a hernia can get triggered from heavy weight lifting, constant coughing, gaining weight and from irregular bowel movement. 80percent of hernia cases originate near the groin.

What are the symptoms?
Some of the common symptoms of a hernia include:

Constipation
Nausea
Feeling of fullness even without eating a thing
Sharp pain while lifting weight
Burning sensation
Dull ache near the groin area
Bulge near the groin area
How is a laparoscopic hernia performed?
This mode of surgery uses a telescope-like instrument known as the laparoscope. With the help of a small incision, the laparoscope is inserted at the belly button. Since the procedure is performed withanaesthesia, it isessential for a doctor to do a routine medical check-up that evaluates the general health of the patient, past medical history, EKG, blood work etc.

Usually, the patient doesn t feel a thing while the surgery is performed. A video camera is connected to the instrument to get a detailed inside view of a hernia and the area that needs to be repaired. Before this, the abdomen is inflated with the help of carbon monoxide. A mesh is placed inside the abdomen to fix the defects of the abdominal wall and strengthen the weakened tissue of the abdomen. Once the procedure is done, the incisions that are made in the abdomen is closed with the help of surgical tapes. The mark of incision disappears within a month.

Benefits of Laparoscopic Hernia Surgery
The benefits of laparoscopic surgery are quite evident.

A lot of tiny incisions are made rather than making a large incision in the abdominal area. This ensures speedy recovery and a short stay at the hospital.
The pain is significantly less compared to the conventional surgery.
The cost of a laparoscopic surgery is lesser
Lastly, a speedy recovery can ensure that a person can return to work within a few days after the surgery is performed.
What to expect after the surgery
Doctors often suggest a week of complete rest after the surgery. The healing time can vary from person to person. A surgeon typically prescribes antibiotics and pain medications to cope up with the wound and pain. It must be ensured that these medicines are taken on time. A revisit to the surgeon might be required after a couple of weeks to assess the recovery.

An Overview Of Laparoscopic Hernia Surgery!

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

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

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?

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