Can You Get a Hiatus Hernia Removed?
Yes, a hiatus hernia can be surgically removed or, more accurately, repaired. While the hernia itself isn’t removed in the traditional sense, the procedure involves repositioning the stomach and reinforcing the diaphragm to prevent further herniation.
Understanding Hiatus Hernias
A hiatus hernia occurs when a portion of the stomach pushes up through the diaphragm, the muscle separating the chest and abdomen. This opening in the diaphragm is called the hiatus. There are two main types of hiatus hernias:
- Sliding hiatus hernia: This is the most common type, where the stomach and the gastroesophageal junction (where the esophagus and stomach meet) slide up into the chest.
- Paraesophageal hiatus hernia: A more severe type, where part of the stomach squeezes through the hiatus and lies next to the esophagus. This type carries a higher risk of complications.
Symptoms and Diagnosis
Many small hiatus hernias cause no symptoms. However, larger hernias can lead to:
- Heartburn
- Regurgitation of food or liquids
- Difficulty swallowing (dysphagia)
- Chest or abdominal pain
- Feeling full quickly when eating
- Shortness of breath
Diagnosis usually involves:
- Upper endoscopy: A thin, flexible tube with a camera is inserted into the esophagus and stomach to visualize the area.
- Barium swallow X-ray: The patient drinks a barium solution, which coats the esophagus and stomach, allowing them to be seen on an X-ray.
- Esophageal manometry: Measures the pressure and coordination of muscle contractions in the esophagus.
- pH monitoring: Measures the amount of acid reflux into the esophagus.
When is Surgery Necessary?
Not all hiatus hernias require surgery. Treatment often starts with lifestyle modifications and medications to manage symptoms. Surgery is typically considered when:
- Symptoms are severe and don’t respond to medication.
- There are complications, such as esophageal strictures (narrowing) or Barrett’s esophagus (precancerous changes in the esophageal lining).
- The hernia is a large paraesophageal hernia, which poses a higher risk of strangulation (blood supply cut off to the herniated stomach).
The Hiatus Hernia Repair Procedure
The surgical procedure to repair a hiatus hernia is called hiatal hernia repair or fundoplication. It usually involves these steps:
- Repositioning the stomach: The surgeon pulls the stomach back down into the abdominal cavity.
- Repairing the hiatus: The hiatus (opening in the diaphragm) is tightened by stitching the muscle tissue together.
- Fundoplication: The upper part of the stomach (the fundus) is wrapped around the lower esophagus and stitched in place. This reinforces the lower esophageal sphincter (LES), which prevents acid reflux.
There are two main approaches to hiatal hernia repair:
- Laparoscopic surgery: This is the most common approach, using small incisions and a camera to guide the surgery. It is minimally invasive, resulting in less pain and a faster recovery.
- Open surgery: This involves a larger incision in the abdomen or chest. It may be necessary for complex cases or when laparoscopic surgery is not possible.
Benefits and Risks of Surgery
Benefits:
- Relief from heartburn and regurgitation
- Improved ability to swallow
- Reduced risk of complications from acid reflux
- Improved quality of life
Risks:
- Bleeding
- Infection
- Difficulty swallowing (dysphagia) – can be temporary or, rarely, permanent.
- Gas bloat syndrome (difficulty belching or vomiting)
- Recurrence of the hernia
- Damage to surrounding organs
Recovery After Hiatus Hernia Repair
Recovery time varies depending on the type of surgery.
| Factor | Laparoscopic Surgery | Open Surgery |
|---|---|---|
| Hospital Stay | 1-3 days | 5-7 days |
| Return to work | 2-4 weeks | 6-8 weeks |
| Dietary Restrictions | Soft diet for several weeks | Soft diet for several weeks |
Common Mistakes and Misconceptions
- Mistake: Believing that surgery completely eliminates the possibility of reflux. While surgery significantly reduces reflux, it’s not always a complete cure.
- Misconception: That hiatus hernia removal is a simple procedure. While often successful, it’s a complex surgery with potential risks.
- Mistake: Not following post-operative dietary guidelines. This can lead to complications and delayed healing.
Lifestyle Changes After Surgery
Maintaining long-term success after hiatal hernia repair often involves lifestyle modifications:
- Eating smaller, more frequent meals
- Avoiding lying down for at least 3 hours after eating
- Elevating the head of the bed
- Avoiding trigger foods (e.g., caffeine, alcohol, chocolate, fatty foods)
- Maintaining a healthy weight
- Quitting smoking
Frequently Asked Questions
Will the pain immediately disappear after surgery?
The level of pain reduction varies. While many patients experience significant relief from heartburn and other symptoms, it’s normal to experience some post-operative pain and discomfort, which can be managed with medication. Complete symptom resolution may take several weeks or months.
How long does hiatus hernia surgery take?
The duration of the surgery depends on the complexity of the case and the surgical approach. Laparoscopic hiatal hernia repair typically takes between 1.5 to 3 hours. Open surgery may take longer.
Is there a way to prevent a hiatus hernia from recurring after surgery?
While there’s no guarantee, following post-operative instructions, maintaining a healthy weight, and avoiding activities that put excessive pressure on the abdomen can help minimize the risk of recurrence. Regular follow-up appointments with your surgeon are also important.
What type of doctor performs hiatus hernia surgery?
Hiatal hernia surgery is typically performed by a general surgeon or a bariatric surgeon who specializes in gastrointestinal surgery. Look for a surgeon with extensive experience in laparoscopic hiatal hernia repair.
What are the chances of needing another surgery for a hiatus hernia in the future?
The recurrence rate varies, but generally, the success rate of hiatal hernia repair is high. However, some patients may experience a recurrence over time, requiring additional treatment or surgery. The specific risk depends on several factors, including the size of the original hernia and the surgical technique used.
Are there any alternatives to surgery for a hiatus hernia?
Yes, alternative treatments focus on managing symptoms. These include lifestyle modifications such as dietary changes and weight loss, and medications such as antacids, H2 blockers, and proton pump inhibitors (PPIs). However, these alternatives do not correct the hernia itself.
Can Can You Get a Hiatus Hernia Removed? surgery be done robotically?
Yes, some surgeons perform hiatal hernia repair using a robotic-assisted approach. This technique offers enhanced precision and visualization, potentially leading to improved outcomes in certain cases. However, the availability and suitability of robotic surgery depend on the surgeon’s expertise and the patient’s specific situation.
What kind of diet should I follow before and after hiatus hernia surgery?
Before surgery, your doctor will likely recommend a light, easily digestible diet. After surgery, you will typically start with a liquid diet and gradually progress to a soft diet for several weeks. You should avoid foods that trigger heartburn or are difficult to swallow.
How soon after surgery can I start exercising again?
You should avoid strenuous activity for several weeks after surgery. Your doctor will provide specific guidelines based on your individual recovery. Gentle walking is usually encouraged soon after surgery.
Are there any long-term side effects of hiatus hernia surgery?
While rare, some long-term side effects can include difficulty swallowing (dysphagia), gas bloat syndrome (inability to belch), and dumping syndrome (rapid gastric emptying). These complications are usually manageable with medication and dietary modifications.
What questions should I ask my surgeon before agreeing to hiatus hernia surgery?
Key questions to ask include: “What is your experience with this type of surgery?”, “What are the potential risks and complications?”, “What are the chances of recurrence?”, “What type of surgical approach will you use?”, and “What is the recovery process like?”. It’s crucial to be well-informed before making a decision.
Is it possible to live with a hiatus hernia without surgery?
Yes, many people with small hiatus hernias can manage their symptoms effectively with lifestyle changes and medication. However, if symptoms are severe or complications develop, surgery may be necessary to improve quality of life and prevent further problems. Deciding “Can You Get a Hiatus Hernia Removed?” is a personal choice based on symptom severity and response to conservative management.