HIATAL HERNIA

Dr. Chiasson has been performing Hiatal Hernia Repair and Anti-Reflux Surgery since the beginning of his Minimally Invasive Surgery practice in Southern Arizona in 2002.  He has a strong interest in Foregut Surgery and has been an early adopter of new techniques and new technology in this area of practice.

What is a Hiatal Hernia?

Any time an internal body part pushes into an area where it doesn’t belong, it’s called a hernia. The hiatus is an opening in the diaphragm – the muscular wall separating the chest cavity from the abdomen.  Normally, the esophagus goes through the hiatus and attaches to the stomach.  In a hiatal hernia, the stomach bulges up into the chest through that opening.

 

Are there different types of Hiatal Hernias?

There are different types of Hiatal Hernias.  They are classified as Types I-IV.  Type I Hiatal Hernias are the most common.  It is thought that 15% of normal-weight adults and 30% of obese adults have a hiatal hernia.  Type I Hiatal Hernias account for 95% of all Hiatal hernias.  These are considered to be smaller hernias.  Types II, III, and IV are called Para-esophageal Hernias.

 

What happens to Hiatal Hernias over time?

It is important to know that Hiatal Hernias do not go away over time.  They may not change much once a diagnosis is made.  However, most will become larger and may begin to cause worsening symptoms.

 

What symptoms are associated with Type I Hiatal Hernia?

Type I Hiatal Hernias are commonly associated with GERD/LPRD symptoms.  Gastroesophageal reflux disease (GERD) is a chronic digestive disease that occurs when stomach acid or, occasionally, bile flows back (refluxes) into your food pipe (esophagus). The backwash of acid irritates the lining of your esophagus and causes GERD signs and symptoms that are generally referred to as heartburn

Laryngopharyngeal reflux (LPRD), also known as proximal reflux, extraesophageal reflux disease, silent reflux, and supra-esophageal reflux, is caused by the flow of stomach contents back up through the esophagus and back into the larynx, oropharynx and/or the nasopharynx. This causes chronic conditions such as cough, hoarseness, sore throat, etc.

 

What are the indications for repairing a Type I Hiatal Hernia?

Type I Hiatal hernias are generally only repaired as part of GERD/LPRD anti-reflux treatment.  As such, the indications for surgery in this setting are for patients who:

    1. do not want to take medicine for life
    2. are allergic to antacid medications
    3. develop resistance to antacid medications
    4. have worsening symptoms despite taking medications
    5. develop complications despite taking PPI medications. (ie. bleeding, ulcers, strictures)
    6. have LPRD that is not controlled with medication.

 

What should you expect after a Type I Hiatal Hernia Repair?

Laparoscopic Repair of a Type I Hiatal Hernia is an outpatient procedure.  It is performed under general anesthesia.  I use the latest pain and nausea control techniques and most patients experience minimal symptoms afterward.

 

What are the indications for repairing a Type II, III, IV Para-Esophageal Hernia?

Para-esophageal hernias are less common than large Hiatal hernias.  Sometimes these hernias are discovered with tests but do not seem to be causing any problems. There is some controversy regarding the indications for repairing these hernias in this setting.  However, when they start to cause symptoms such as chronic anemia due to Cameron’s ulcers or more significant atypical chest pain, upper abdominal pain, and difficulty swallowing; it is a cause for concern and they should be repaired.  These symptomatic para-esophageal hernias are at higher risk for progressing to incarceration (stomach gets stuck resulting in obstruction) or ischemia (blood supply to the stomach is cut off) resulting in the need for emergency surgery.

 

What should you expect after a Para-Esophageal Hiatal Hernia Repair?

Laparoscopic repair of a larger type II, type III, and type IV Para-esophageal Hiatal Hernia is potentially more complex.  Typically, patients with these types of hernias are older and have multiple medical conditions.  In the past, many patients were not referred for surgery because of risk concerns.

Laparoscopic Repair of Para-esophageal Hernias is now considered routine when performed by more specialized surgeons.  Patients experience minimal pain and are usually discharged home in 1-2 days – even older patients.  More importantly, the use of newer relaxation techniques and types of mesh has markedly decreased the risks of hernia recurrence.  Patients now can expect to have a big operation through small incisions that leave them with an excellent quality of life.

 

Can prior Hiatal Hernia Surgery be Revised?

There are patients who undergo Laparoscopic Hiatal Hernia Repair who may experience recurrent symptoms or complications because of a recurrent hiatal hernia, LINX problems, or a slipped wrap causing difficulty swallowing.   These patients require extensive evaluation and may be candidates for laparoscopic revision surgery to address their issues.

READY TO GET STARTED WITH DR. CHIASSON?

In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese. You are not alone and you do not need to feel any less of a person if you are overweight or obese. Take action now and increase your quality of life.