Sometimes gastrointestinal symptoms can be an indication of something bigger, like a hiatal hernia. If you’re experiencing persistent reflux, regurgitation, or a sense of fullness when you haven’t eaten much, you could have a hiatal hernia. Here’s what you need to know.
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 different types of hiatal hernias, each based on the level of severity. Most patients experience the lesser severe hernias as the more serious ones take decades to develop and worsen.
“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,” Dr. Michael Valliere, MD, surgeon at The Iowa Clinic says. “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 really sick from that, but it’s less than 1% of patients we see 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,” Dr. Valliere says.
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. As long as the patient isn’t experiencing any of the more serious symptoms, there isn’t much health risk to waiting for surgery.
Treatment options for a 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,” Dr. Valliere says.
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, there’s a lot of discussion to try to eliminate that fear of the unknown,” Dr. Valliere says.
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, patients are seen in pre-op by the surgeon, anesthesiologist, and nursing. In the operating room (OR), patients undergo general anesthesia, are positioned for the operation, and the procedure is performed minimally invasively, through small incisions,” Dr. Valliere says.
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.
After surgery, patients are admitted for the night to undergo observation.
“In post-op, we start them out on clear liquids. We make sure they are tolerating clear liquids, then we graduate them to full liquids (soup, pudding, soft foods). As long as they are tolerating that and their pain is under control, they are safe to be discharged the day following the surgery,” Dr. Valliere said.
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, we 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. They can gradually move on to more food, but we still recommend taking in smaller bites and smaller portion sizes,” Dr. Valliere says.
Beyond the six-week point, patients 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 PCPs, GI, and specialty surgeons, we do a good job from start to finish with things like a hiatal hernia, or anything requiring cross-department collaboration. It flows very well, and the continuum of care is seamless for the patient. We communicate well between departments. We have excellent GI and PCP departments that do a very good job for our group,” Dr. Valliere says. “We’re adept with minimally invasive hiatal hernia due to comfort with the case and high volume. We have several of us that do this repair and are very comfortable with it, and we work collaboratively and well together.”
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.
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MichaelValliere , MD
Michael Valliere, MD joined The Iowa Clinic because of our positive and collaborative atmosphere and focus on optimal care for every patient.
General surgery affords Dr. Valliere the opportunity to treat a wide variety of patients and diseases, as well as work among a multi-specialty group. He understands preparing for and going through surgery can often evoke worry and stress, which is why reassuring his patients and their families is a top priority.
Outside of work, he enjoys spending time with his wife and two sons, as well as bicycling and running. If he wasn’t a surgeon, he wishes he could be a professional cyclist.