Strange, Weird & Bizarre Medical Cases & Facts

Facts About Hiatal Hernia

Hernias are protrusions of vital structures into an area where they don’t belong and can occur out of the chest wall from the lungs or through the diaphragm from the abdomen. Hernias require surgery when the function of the herniated organ is compromised.  The most common type of hernia to occur through the diaphragm is a hiatal hernia.  This occurs when the stomach comes through the diaphragm at the “hiatus” and sits in the chest and is a common condition. In fact, by age 60, approximately 60 percent of people have a hiatal hernia.

While small hiatal hernias may cause reflux, they may not necessitate surgery.  People who are over age 50, smoke or are obese are at the highest risk for a hiatal hernia.  Other contributing factors may include:
•    Poor seated posture
•    Frequent coughing
•    Straining with constipation
•    Heredity
•    Congenital defects

For most people, a hiatal hernia causes no symptoms.  However, if a vital organ such as a portion of the stomach, intestines or other abdominal organs slide up through the hiatus, this is called a pera-esophageal hernia and there may be symptoms which include:

•    Chest pain or pressure
•    Heart burn
•    Coughing
•    Belching

Many people learn they have hiatial hernia’s when they go to their doctor complaining of heart burn.  To determine if you have a hiatal hernia’sm your doctor will likely order a barium x-ray or an endoscopy.  In a bariaum x-ray, the patient drinks a chalky fluid which coats the inside of the esophagus and stomach to their anatomic relationship.  An x-ray is then taken which will show if food is backing up. An endoscopy involves passing a flexible scope with a camera at the end of it into your mouth and down the esophagus to examine it and the stomach.

Many people are able to control the effects of a small hiatal hernia through diet and medication.  Changes in diet include reducing the amount of caffeine, chocolate, fatty foods and foods high in acid.  Additionally, people who are overweight often feel relief when they lose weight.  When treated with medication, people are prescribed medications which reduce the amount of acid in the stomach.

For people for whom lifestyle changes and medication are not effective, or for those with chonic bleeding, narrowing or obstruction of the esophagus, surgery may be necessary.  This is especially true for larger hiatal hernias and para-esophageal hernias.  If surgery is necessary, the surgeon will reduce the contents of the hernia back into the abdomen, remove the hernia sac and close the area where the hernia had been situated.  The surgery is performed in one of several ways, depending on the surgeon and a patient’s individual needs.  Sometimes, a single incision in your chest or abdomen.  Alternatively, several small incisions are made in the abdoment is made and the surgery is performed using instruments and a camera to visualize the inside of the patient on a monitor.   This is called Video Assisted Thoracoscopic Surgery or VATS.

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