Hiatus Hernia

The Hiatus is the area of the diaphragm where the gullet passes through from the chest to the abdominal cavity. It is a natural area of weakness where structures can push through where they don’t belong. There is often quite a bit of confusion about this problem and particularly which need to have an operation and which are dangerous.

Mythbusters about Hiatus Hernia

• Hiatus hernia and reflux are NOT the same thing!
  • But a hiatus hernia can sometimes make reflux symptoms worse.
• Not all hiatus hernias need to be fixed!
• Not all hiatus hernias are equal!
• A gastroscope study doesn’t always tell you the right information about a hiatus hernia. Sometimes other studies need to be done if things aren’t quite right.
• While they sound the same, this is not the same as a groin hernia or belly button hernia.
• Hiatus hernias are often a result of obesity, repeated high abdominal pressures and/ or an underlying connective tissue weakness.

The most common type of hiatus hernia is called a “sliding hernia” where the stomach moves in and out of the chest. The ligament holding it down is loose and so the stomach can move unhindered. Quite often these are causing no symptoms and can be left alone.

A “rolling” hernia is where a lower part of the stomach pushes through the diaphragm but the junction between the gullet and stomach remains put. This is very similar to a “para-oeosphageal” hernia otherwise known as large or massive hiatus hernia. These last two often cause problems and can actually be dangerous, sometimes blocking the blood supply to part or all of the stomach. These large hernias also sometimes contain other abdominal organs like the spleen, pancreas or large bowel.

Some patients get a hiatus hernia following a previous stomach operation. Sometimes we see this after a sleeve gastrectomy and the approach to treatment is slightly different in the cases.

Any patient with a hiatus hernia can come along and speak with our surgeons about what is going on. A discussion is not a commitment to an operation and we will take it slow and steady, explaining every step of the process. We will usually arrange a few tests to show exactly what is going on and after we have all the information, most people are able to understand the reasons for our recommendations.

If surgery is recommended, it is usually not as great an impact on people as sometimes feared:

• Usually keyhole operation,
• 2 – 3 nights in hospital,
• Pain usually controlled well with minimal heavy painkillers when going home, and
• Back to normal duties after a couple of weeks.

This is quite a technical problem that needs subspecialist care. Southern Surgical Care has a special interest in managing Hiatus Hernia and welcome all patients along to discuss.