Hiatal Hernia Surgery
When we think of hernias we often think of the most common forms – inguinal or groin hernias. We’re told not to strain too hard, otherwise we could develop a hernia. And while there are several types of hernia, most in the groin and lower abdominal area, there is one outlier – the hiatal hernia.
A hiatal hernia occurs in the upper abdomen at the hiatus or opening of the diaphragm. Usually, the esophagus passes through the hiatal opening, but it is possible for the stomach to push through from below instead. While this may seem like a painful condition, many people do not have symptoms and won’t know they even have a hiatal hernia.
The causes of hiatal hernias are largely unknown, though risk factors such as overexertion, hard coughing, age and excess weight seem to play a role. Some patients will have had their hiatal hernia since birth.
The relationship between a hiatal hernia and GERD is not well established. It would make sense that there is a link between the two, however not everyone with a hiatal hernia has GERD and vice-versa. Since we know that overweight people are at greater risk for a hiatal hernia – a similar risk factor for GERD as well – a common condition may be the cause of both the hernia and GERD.
The most concerning issue associated with a hiatal hernia is the potential for the stomach to strangulate. This occurs when the blood supply is cut off to the area of the stomach trapped in the hiatal opening. Strangulation is an emergency situation that requires immediate surgery. Strangulation often causes severe pain in the chest or abdomen, vomiting and more. Of course, as with any emergency, do not delay in calling 911.
Some patients undergoing bariatric surgery will find out about a hiatal hernia during their pre-op testing. At this point, depending on the hernia’s severity, the patient and their surgeon will decide if they should address the hernia at the same time as the primary bariatric procedure. Depending on the characteristics of the hernia, a minimally invasive procedure to address both issues is possible, however there is a chance that the surgery would have to be converted to open.