Hiatus hernia
What is a hiatus hernia?
A hiatus hernia occurs when part of the stomach moves upward through the diaphragm into the chest. Sliding hiatus hernias are the most common and are often associated with reflux. Larger hiatus hernias may cause difficulty swallowing or chest discomfort and, occasionally, the stomach can twist or become trapped, causing an obstruction.
Symptoms
Reflux and pressure symptoms
Symptoms can include heartburn, regurgitation, difficulty swallowing, chest discomfort, early fullness during meals and, with larger hernias, shortness of breath.
Investigation
Tests that may be required
Assessment may include gastroscopy, a barium swallow, oesophageal manometry and a 24-hour pH study. The tests required depend on the symptoms and whether surgery is being considered.
Treatment
Lifestyle, medication and surgery
Lifestyle measures and acid-suppressing medication help many patients. Surgery may be considered when symptoms remain troublesome despite medical therapy, when complications occur, when a large or paraoesophageal hernia is present, or when a patient wishes to avoid long-term medication after appropriate assessment.
Surgery
Laparoscopic or robotic hiatus hernia repair
Keyhole surgery returns the stomach to the abdomen and narrows the enlarged opening in the diaphragm. A fundoplication (wrapping part of the upper stomach around the lower oesophagus) is often added to reduce reflux. The approach is tailored to the hernia, symptoms and pre-operative investigations. Mesh is considered selectively rather than routinely, as evidence for preventing recurrence is uncertain.
Recovery
Eating and recovery after surgery
Most patients stay overnight and are encouraged to walk soon after surgery. A staged diet of fluids, puréed foods and then soft foods allows postoperative swelling to settle; the pace is individualised. Small meals, slow eating and careful chewing can help. Driving and return to work depend on comfort, pain medication and the nature of your work.
Patient resourcesRISKS OF HIATUS HERNIA REPAIR
Important risks and complications
Hiatus hernia repair and fundoplication are generally safe, but complications can occur. Individual risks depend on the size of the hernia, previous surgery and other medical conditions.
General surgical risks
Bleeding, infection, anaesthetic complications, chest complications, blood clots in the legs or lungs and, rarely, heart attack, stroke or death. Occasionally, further procedures or an open operation may be necessary.
Hiatus repair and fundoplication risks
Temporary or persistent swallowing difficulty, bloating, increased wind and reduced ability to belch or vomit. Less common but important problems include injury to the oesophagus, stomach or nearby organs, leakage following injury, recurrence of the hernia or reflux, and the possible need for further surgery. Some patients continue to need reflux medication.
Your individual risks, expected benefits and alternatives are discussed during consultation before surgery.