Hiiatal hernias generally develop when the stomach’s upper parts manage to push through a diaphragm opening, reaching the chest cavity. The diaphragm is the thin muscle that separates the abdomen and the chest cavity, while the opening of the diaphragm is where the stomach and the esophagus join. 

If you’re interested in hiatal hernia surgery in Miami, you may find this expert-approved article helpful, in which our expert team talks about the main causes of hiatal hernias, discuss options for hiatal hernia repair, and other essential information. 

Causes of Hiatal Hernias and Symptoms

These hernias can occur in people of all ages and genders. Still, it’s most prevalent in people around 50 and older and seems to develop more often in obese/overweight individuals and those who smoke. 

Regarding the cause of hiatal hernia, the condition most often develops due to a pressure increase in the abdominal cavity, which is the space in the middle of the human body, holding several organs, such as the:

  • Kidneys
  • Liver
  • Gallbladder, spleen, pancreas
  • Lower esophagus, stomach
  • Small intestine
  • Colon
  • Rectum
  • Bladder

Typically the pressure can build up from several things, such as coughing, straining during bowel movements, heavy lifting, physical strain, or vomiting.

In other instances, hiatal hernias may develop during pregnancy, with obesity, or when there’s extra fluid present in the abdomen.

Most people with the condition produce no symptoms, while others may experience the same signs that come with GERD or gastroesophageal reflux disease. The latter develops when the stomach’s digestive juices reach the esophagus and produce the following symptoms:

  • Belching and bloating
  • Heartburn
  • Pain and discomfort in the esophagus and stomach
  • Sour or bitter taste in the throat

Additionally, chest pain may also be a hiatal hernia symptom. And since it may also be a heart attack symptom, it’s essential to contact your doctor or go to the ER if you are experiencing it. 

Young Woman With a Sore Throat Drinking Tea

Diagnosing Hiatal Hernias

Several tests can help in establishing a diagnosis. They can range from the barium swallow test to gastric emptying and pH tests.

  • Barium swallow: This involves drinking a special liquid along with the use of X-rays to help see if there’s any problem in the stomach or the esophagus. In this case, it can show the size of the hernia and whether the stomach has twisted due to the condition. 
  • Esophageal manometry: This measures the muscle coordination and strength of the esophagus while swallowing.
  • Endoscopy: This involves viewing the upper digestive system with a long, flexible, and thin instrument that’s about ½ inch in diameter, the endoscope. 
  • Gastric emptying studies: These tests examine the rate at which the food leaves the stomach. The test results are beneficial for those patients who experience vomiting and nausea, as there could be other underlying conditions besides the hiatal hernia.
  • pH tests: These measure esophageal acid levels, which can help determine which symptoms can be directly linked to the acid in the organ. 

Hiatal Hernia Treatment

For the most part, hiatal hernia repair isn’t required. Still, for those patients who have GERD-like symptoms with their hernias, treatment may include those methods that help with managing the symptoms of reflux. These will usually include the following lifestyle changes:

  • Decreasing meal portion sizes
  • Maintaining a healthy weight
  • Staying away from acidic foods like juices, tomato sauce, and citrus fruits, which can irritate the lining of the esophagus
  • Limiting fatty and fried foods
  • Caffeinated drinks, carbonated beverages
  • Beverages with alcohol
  • Vinegar, ketchup, mustard
  • Eating meals earlier before lying down
  • Keeping your head higher than the rest of the body by at least six inches when resting on your back to keep the stomach’s contents from rising
  • Quitting tobacco use
  • Avoiding tight belts and clothes that may increase abdominal pressure
  • Taking certain medications after meals to reduce stomach acid

In some cases, patients may be recommended to use proton-pump inhibitors to treat the hernia. The medication helps decrease the amount of stomach acid, helping with reflux. 

Also, in other cases, OTC medications can help relieve the symptoms associated with hiatal hernias. Antacids are the most prevalent compounds that can bring relief, but if patients fail to see improvement after using them for longer than two weeks, their doctor might recommend them prescription options instead.

Hiatal Hernia Repair

When the portion of the stomach protruding into the chest cavity is too large and starts cutting off blood supply, doctors will recommend surgery. 

Surgical interventions are also an option for those who are experiencing chronic reflux symptoms that don’t respond to any medical treatments. The goal of the latter surgery is to address the reflux by introducing a more efficient valve mechanism at the esophageal bottom. Acting as a swinging door, it opens when it needs to let food enter the stomach but closes correctly to keep the contents of the stomach from entering the esophagus. 

Typically, when the valve doesn’t work as it should, the stomach’s contents may damage the esophagus, causing inflammation or esophagitis, along with scarring, bleeding, and the formation of esophageal ulcers. 

Young Sick Man Sitting on the Couch in the Doctor’s Office and Pointing to Stomach During Medical Examination in Clinic.

Performing Hiatal Hernia Repair Surgery

Hiatal hernia treatment usually involves:

  • Pulling the protruding portion back into the abdominal cavity.
  • Improving the esophageal valve.
  • Closing the diaphragm muscle’s hole.

During hiatal hernia repair, the healthcare expert will wrap the fundus (the upper stomach) around the esophagus’ lower portion, creating a tight sphincter and eliminating the problem of the stomach contents moving back into the esophagus.  

Fundoplication offers two versions of this procedure. Open fundoplication will mean a larger incision, and it’s primarily performed in severe cases allowing greater accessibility and visibility during the procedure. Still, it will result in a prolonged recovery time for the patient and hospital stay. 

On the other hand, fundoplication may also be done with the help of a laparoscope, where doctors will make several tiny incisions. This is called the Nissen fundoplication, creating a permanent solution to all symptoms. During the intervention, the doctor will make no more than five or six small abdominal incisions with the laparoscope and uses other medical instruments to wrap the fundus around the esophagus and create the tight sphincter. 

Needless to say, Nissen fundoplication has several advantages when compared to open surgery, such as:

  • Smaller incision
  • Lesser infection risks
  • Faster recovery
  • Less scarring and pain

Learn About Available Options

Generally speaking, Nissen fundoplication is very effective for those patients who require hiatal hernia repair. That said, open surgery is also effective, but it will require a more extended hospital stay and longer recovery, and the chances of complications may also be a bit higher. Still, in either case, most patients will need no long-term treatment with medications. 

Looking to learn more about these hernias and available treatment options? Contact Surgical Solutions of Miami and explore the latest treatment options available.