What is a hiatal hernia?
A hiatal hernia is quite different from other hernias. It is caused when the diaphragmatic hiatus (essentially, the hole where your esophagus passes through the diaphragm and empties into the stomach), is larger than it should be and, as a result, the stomach herniates through that hole and into the chest.
There are four types of hiatal hernias, each based on the level of severity. The vast majority of hiatal hernias are called type I, or sliding hiatal hernias. In this type, the stomach intermittently slides up into the chest through a small opening in the diaphragm. Type II, III and IV hiatal hernias are called paraoesophageal hernias.
There’s a huge gradient of severity with hiatal hernias. Many of them small - they start with what’s called a Type 1 sliding where just the first part of the stomach, or the gastroesophageal junction, is herniating into the chest cavity. Patients may be completely asymptomatic at this point, they may experience reflux or heartburn but these may be minor symptoms.
As the hernia enlarges, symptoms may become worse including early satiety or feeling full quickly, because food can be stuck in the stomach within the chest. Some other cases can include upper GI tract bleeding or rarely what’s called gastric volvulus, which is when the stomach twists in the chest cavity and loses blood flow. You can get sick from that, but it’s less than 1% of patients The Iowa Clinic surgeons sees annually.
How are hiatal hernias diagnosed?
Often, hiatal hernias present with GI symptoms first, but the most obvious tool for diagnosis is imagery via endoscopy or CT, ordered by your primary care provider or a GI specialist. Once imaging or endoscopy has been performed, it’s really easy to tell if you’re dealing with a hiatal hernia or not.
After a hiatal hernia has been identified and diagnosed with imaging, treatment options are discussed. Many patients may choose not to undergo surgery to correct the hernia until they are suffering from more serious symptoms. If the patient isn’t experiencing any of the more serious symptoms, there isn’t much health risk to waiting for surgery.
What are the treatment options for hiatal hernia?
When it comes to treating hiatal hernias, the main course of treatment is surgery. Surgical repair is the only real “cure” for a hiatal hernia. The size of the hernia, symptoms, and the patient’s overall health help determine the necessity and timing of surgery.
What should I expect with hiatal hernia surgery?
When it’s time for the operation, The Iowa Clinic follows the safest and most minimally invasive procedures possible to repair the hiatal hernia.
First, you’ll discuss any concerns with your doctor and surgeon. It can be a challenging topic for patients to visualize because they can’t see the hernia, but they do experience the symptoms. So, The Iowa Clinic surgeons know the importance of discussing these concerns to try to eliminate that fear of the unknown.
In the weeks leading up to the surgery, you’ll have further imaging via endoscopy, CT, and other internal imaging methods to prep for the surgery.
On the day of surgery, you are seen in pre-op by the surgeon, anesthesiologist, and nursing. In the operating room (OR), you will undergo general anesthesia and the procedure is performed minimally invasively, through small incisions.
The procedure involves pulling the herniated portion of the stomach back into the abdomen where it belongs and then sewing the diaphragmatic hiatus to a size that only accommodates the esophagus, which prohibits the stomach from herniating into the chest again.
What is the recovery for hiatal hernia surgery?
After surgery, patients are admitted for the night to undergo observation.
In post-op, you will be started on clear liquids. The Iowa Clinic team makes sure you are tolerating clear liquids, then will graduate you to full liquids (soup, pudding, soft foods). If you are tolerating that and your pain is under control, you are safe to be discharged the day following the surgery.
After being discharged, patients can typically resume a relatively normal life. Two weeks post-op, patients return for a postoperative evaluation.
At the two-week checkup, you will re-discuss longer term recovery guidelines. Patients are instructed not to lift more than 20 pounds for six weeks after surgery to reduce abdominal pressure and decrease the risk of recurrence. You can gradually move on to more food, but it is still recommend taking in smaller bites and smaller portion sizes.
Beyond the six-week point, you should try to adopt a healthier lifestyle to avoid a recurrence of the hernia. Patients should aim to maintain a healthy weight and refrain from smoking. This gives the tissue the best chance at healing properly and retaining strength.
Managing Your Health Better with Coordinated Care at The Iowa Clinic
At The Iowa Clinic, the Coordinated Care model makes it easier to seek treatment for conditions like hiatal hernia that require multiple specialties.
Given the fact that TIC has a great multi-specialty clinic with Primary Care Providers, Gastroenterology specialists and specialty surgeons, we can provide comprehensive care from start to finish for things like a hiatal hernia. The Iowa Clinic providers communicate well between departments and are adept with minimally invasive hiatal hernia due to comfort with the case and high volume of patients seen for this condition.
If you are worried about your GI health or believe you may be experiencing symptoms of a hiatal hernia, contact your primary care provider or request an appointment at The Iowa Clinic today.