Hiatus hernia: cause, diagnosis and surgery

Written by: Mr Krishna Moorthy
Published: | Updated: 29/11/2018
Edited by: Top Doctors®

Different types of hernias are classified by their anatomical location, however a hiatus hernia is unlike most common types such as an inguinal or an umbilical hernia that appear in the abdomen, as it is a weakness in the diaphragm meaning the surgery is usually more complicated.
 

Mr Krishna Moorthy, a leading surgeon based in London specialising in hernia surgery, explains just what exactly a hiatus hernia is and how it can be treated... 
 

What is a hiatus hernia?

A hiatus hernia occurs through the hole in the diaphragm (a large, thin sheet of muscle between the chest and stomach) through which the oesophagus (food pipe) enters the abdomen from the chest. When this hole enlarges, a portion of the stomach or sometimes the whole stomach can slip into the chest.

What causes a hiatus hernia?

Just as other hernias, there is not a known cause for them. The large ones often occur in older patients perhaps as the result of the diaphragm becoming weak with age.
 

How is a hiatus hernia diagnosed?

• Sliding hiatus hernia – are smaller ones associated with acid reflux, food and fluid reflux and sometimes chest pain.
• Rolling hiatus hernia – larger ones associated with breathlessness, chest pain and symptoms of acid reflux.

Hiatus hernia symptoms:

Most small hiatus hernias cause no symptoms, yet the larger hiatus hernias can cause more obvious signs such as:

Heartburn
• Burping
• Difficulty swallowing
• Chest or abdominal pain
• Feeling especially full
• Vomiting blood or black stools, which may indicate gastrointestinal bleeding

How is a hiatus hernia treated?

Surgery is indicated for the sliding hiatus hernia mainly due to the symptoms of acid reflux and for large hiatus hernias that cause breathlessness. The steps of the surgery are:

1. to restore the lower portion of the oesophagus and stomach back into the abdomen
2. To narrow the hiatus with some sutures
3. To create a new valve, called a fundoplication.

Large hiatus hernias may need a mesh to prevent recurrence of the hernia.

Lifestyle changes also help, such as losing weight; eating smaller meals during the day rather than three large meals; eating three hours before going to bed; avoid lying down straightaway, and removing certain foods and drinks that can make the symptoms worse.
 

Who is at risk for a hiatus hernia?

The larger hiatus hernias are usually found in older patients. Obesity is a known risk factor for the smaller hiatus hernias.

What are the risks of surgery?

The risks of surgery are minimal. The surgery is nearly always performed by laparoscopic (key-hole) surgery. Most patients stay in hospital for just one night. Serious complications are extremely rare. The most common side effect of the operation is a small difficulty in swallowing due to the new valve. Patients can eat soft till the swallowing comes back to normal and this takes around 2 months. Other side effects are abdominal bloating.

Myths associated with surgery

There are certain myths associated with the surgery such as the inability to burp/ belch and vomit. This is extremely unusual. Nearly all patients can do this after surgery. Surgery (fundoplication) is a long lasting repair with a known success rate of close to 90% even 10 years after surgery.

By Mr Krishna Moorthy
Surgery

Mr Krishna Moorthy is a ground-breaking London surgeon specialising in general surgery, upper gastrointestinal surgery for cancer, bariatric surgery, and hernia surgery. He performs laparoscopic gastric banding, laparoscopic gastric bypass, and laparoscopic sleeve gastrectomy. Mr Moorthy currently works at his private clinics alongside a clinic with the NHS.

With more than 25 years of experience in his speciality, Mr Moorthy has dedicated many years to research and development beyond his clinic hours. Most notably, Mr Moorthy was the first to perform the robotic gastric bypass and gastric band in the UK. Over the years, Mr Moorthy has performed over 3000 laparoscopic procedures, of which nearly 2000 are hearnia procedures with a recurrence rate of less than one per cent. Additionally, he is a specialist in the surgical management of cancers of the stomach and the oesophagus, and at present works in the reputable surgical unit in St Mary’s Hospital.

Mr Moorthy has also published in over 80 peer-reviewed papers that have been in highly regarded journals. Furthermore, Mr Moorthy's research extends from surgical table to patient, with topics including information transfer in surgery, multi-disciplinary handover, safety and teamwork in the operating theatre, and safety and quality of care of patients who are undergoing either elective and emergency surgery.

He focuses on improving patient safety and quality of care in surgery. He was involved in the development of the World Health Organisation surgical checklist which is now used throughout the NHS and often gives lectures on surgical training, patient safety in surgery, quality improvement and bariatric surgery. More recently, Mr Moorthy received the BMJ Surgical Team of the Year 2017 award for his lead in developing a novel rehabilitation programme called "PREPARE for surgery", which is a holistic patient programme regularly used within the NHS.

Mr Moorthy's most recent efforts has been co-founding a cancer treatment app called Onko to help educate patients or family and friends about cancer. It "combines the expert support you would get as an inpatient with all the freedoms you would have as an outpatient."

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