Small hernias can sometimes be managed with specific lifestyle changes or medications. In instances in which the stomach muscle has protrude into the esophageal area, however, hiatal hernia surgery may be a recommended treatment approach.
The diaphragm is located between the stomach and the chest area. An opening in the diaphragm, known as a hiatus, is designed to allow food to pass from the esophagus into the stomach. Under certain circumstances, a change, such as a physical trauma, or even age, could cause the loosening in the sphincter that typically keeps food, acids, and muscle from entering the esophageal region.
Ineffectual closing is sometimes responsible for acid escaping out of the stomach area. If stomach muscle passes through the hiatus, a hernia has occurred. Some people may not even know it has happened while others may experience episodes of heartburn that eventually interfere with normal activity.
A small hernia may not require a surgical solution. Sometimes, medications are able to control the heartburn that results from the condition. This might include antacids or proton pump inhibitors. Lifestyle changes may also help. For example, a patient may be advised to stop smoking, to minimize lifting heavy objects, or to lose weight. Modifying the diet is often a reasonable option for reducing the feeling of heartburn as well. In the cases where a larger portion of the muscle has invaded the hiatal opening, however, hiatal hernia surgery may be recommended. Options might include:
The Nissen fundoplication option is performed laparoscopically. A few small incisions are made to accommodate a laparoscope. This instrument possesses a camera which produces an image that guides the surgeon as the procedure moves forward. One incision allows the insertion of the laparoscope. The others permit the surgeon to manipulate the stomach into the desired position. At this time, the typical goal is to tighten the hiatus, making it impassible to the stomach muscle, food, or acid.
In some cases, it may be warranted to conduct an open hiatal hernia surgery. A larger incision is needed under these circumstances. It provides adequate room for a surgeon to reposition the stomach and tighten the sphincter. The term fundoplication means a part of the stomach will be wrapped around the lower portion of the esophagus and sutured into place.
The endoluminal fundoplication procedure is performed via the guidance of an endoscope. This instrument is a thin, flexible tube equipped with a camera. Similar to laparoscopy, the surgeon works by the image produced and strives to tighten the juncture between the esophagus and the stomach. This technique might not have long-term relief but is less invasive and has minimal discomfort. Generally expected to be done as an outpatient procedure, a hospital stay isn’t usually necessary.
Ideally, fundoplication surgeries encourage the easing of prior symptoms or at least reducing them to a point where medications may be more helpful. Many patients are able to go home within a few days following the Nissen fundoplication or the endoluminal fundoplication. Open surgery generally involves a few days of staying in the hospital. Likewise, the recovery period will be longer for anyone who undergoes open surgery. Depending on individual circumstances, a patient might be advised to incorporate smaller meals into their diet the first six weeks. Varying levels of physical activity may also be advised as well as steps to avoid complications, such as incision infections or blood clots. Scarring and pain tend to be minimal during a laparoscopy. An open surgery involves a longer incision, which takes longer to heal and leaves a bigger scar. Visible scarring is not an issue with the endoluminal option since there are no incisions involved.
In the event that a hiatal hernia is suspected, an evaluation and tests can be done to determine a diagnosis. Even when there are no uncomfortable symptoms, it’s best to be aware of the condition in order to avoid unwanted complications later on. Typically, an endoscopy or x-ray is used to view the position of the stomach muscle or the esophageal sphincter’s ability to open and close during digestion. Hiatal hernia surgery generally has low risk and good success rates for people who are appropriate candidates for such options. Ultimately, the goal is to improve the quality of life for the individual suffering the painful heartburn or other side effects of the condition.