The diaphragm is a muscular structure that separates the abdominal cavity from the chest cavity. The esophagus passes through the diaphragm via an opening called the esophageal hiatus.
Sometimes, a portion of the stomach protrudes up through the esophageal hiatus into the chest cavity. When this happens, it is referred to as a paraesophageal, or hiatal, hernia. The majority of hiatal hernia diagnoses are given to adults; however, infants can also form a hiatal hernia.
For many patients, a paraesophageal hernia may not cause any symptoms and, therefore, can often go unnoticed. However, once symptoms present themselves, it may indicate that it is progressing. Common symptoms include:
- Pain in the upper abdomen and/or chest
- Difficulty swallowing
- Feeling short of breath
Hiatal hernias may place individuals at an increased risk of gastroesophageal reflux disease, or GERD. Sometimes, the stomach can become stuck in the hiatal opening. If this happens, surgery will need to be performed as soon as possible.
Causes of hiatal or paraesophageal hernia
Common causes of hiatal hernia include:
- Older age, which predisposes individuals to muscle weakness
- Trauma to the area, such as blunt force
What to expect at your appointment
Individuals with a hiatal hernia will see a doctor for related symptoms, such as GERD. Typically, a hiatal hernia is discovered during diagnostic procedures for upper gastrointestinal symptoms, such as X-ray or endoscopy. Endoscopy allows your doctor to see the inside of the stomach and esophagus and take a small tissue sample using an endoscope, a flexible tube with a light and camera on the tip that is inserted through the mouth.
Hiatal hernias that do not cause symptoms do not require immediate treatment. However, symptom-producing hiatal hernias may need to be treated. They do not heal on their own and require surgical intervention.
Surgical treatment for hiatal or paraesophageal hernia and post-treatment
The majority of paraesophageal hernias can be successfully repaired using laparoscopic techniques. A laparoscope is a flexible tube with a camera on the tip that provides real-time imaging to the surgeon. During a laparoscopic hiatal hernia repair, the surgeon will make five small incisions in the abdomen. The stomach is carefully placed back into its natural position, and the esophageal hiatus in the diaphragm is closed to prevent the stomach from moving back up to the chest cavity. In some cases, the surgeon may place mesh over the opening to reinforce the closure.
The nature of laparoscopic repair as a minimally invasive, minimal incision surgery allows patients to return to work and daily activities sooner than with open surgical procedures. This technique also reduces the amount of time in the operating room, reduces the risk of infection, and patients typically experience less postoperative pain.
Patients may need to stay in the hospital for one to two days after the procedure. Some individuals may experience difficulty swallowing and/or bloating for some time after surgery. These side effects generally resolve with time. Patients may be instructed to follow a diet of liquid foods, and then a transition to soft foods, before reestablishing a normal diet. Additionally, strenuous activities should be avoided for at least six weeks. It is important to follow all postoperative instructions given by the surgeon as well as scheduling and attending all follow-up visits.