Most hernias push through the outer stomach muscles, causing a bulge you may see or feel. Hiatal hernias, on the other hand, develop inside your body. Neither of them heals on their own, and in some cases, you will need hernia surgery.
Dennis L. Streeter, DO, FAAOS, specializes in general surgery and has extensive experience repairing hiatal hernias. However, as an osteopathic surgeon, he takes a holistic approach, recommending the least invasive treatment before surgery.
Hiatal hernias occur when the stomach or other organs push up through an opening in the diaphragm. The diaphragm is a muscle between the chest and abdomen. It has a natural opening (hiatus) allowing the esophagus to reach the stomach.
There are four types of hiatal hernias:
Type 1 (sliding hiatal hernia): Accounts for 95% of all hiatal hernias and develops when the part of the esophagus attached to the stomach slides up through the opening.
Type 2 (rolling hiatal hernia): Accounts for about 5% of hiatal hernias and occurs when the stomach pushes up through the opening.
Type 3: Combination of types 1 and 2.
Type 4: The stomach and other organs, such as the small intestine, colon, pancreas, or spleen, protrude through the diaphragm opening and into the chest.
While an injury may cause a hiatal hernia, the problem usually develops when aging and excessive abdominal pressure weaken the muscles. The pressure may come from:
Being overweight or obese also raises the risk of developing a hiatal hernia.
As organs push through the opening, they stretch the muscle between the esophagus and the stomach. This muscle, the lower esophageal sphincter (LES), opens so food can enter the stomach. Then it closes to keep food and digestive juices inside the stomach.
As the LES weakens, stomach acids can enter the esophagus, causing gastroesophageal reflux disease (GERD). GERD is responsible for hiatal hernia symptoms, such as:
A large hiatal hernia may cause nausea, shortness of breath, or pain during activities like bending, lifting, or coughing.
We recommend the following treatments based on the severity of your symptoms and the hernia:
If you have mild symptoms, we monitor your health and watch for changes in the hernia. We also recommend lifestyle changes that can ease your GERD symptoms, such as:
It also helps if you wait a few hours between eating and lying down.
The first line of treatment is medication to treat GERD. You may need antacids, H2 blockers, or proton pump inhibitors (PPIs).
Antacids neutralize stomach acids. H2 blockers reduce stomach acid production, while PPIs block acid production and help heal the esophagus.
We recommend surgery when:
We typically perform minimally invasive laparoscopic surgery (Nissen fundoplication) to repair a hiatal hernia. Laparoscopic surgery involves tiny incisions and high-tech instruments that fit through the openings, including a laparoscope that lights the area and sends video images to a screen.
During a Nissen fundoplication, we return the stomach, esophagus, and other organs to their proper position below the diaphragm. Then, we rebuild and strengthen the LES using the upper part of the stomach. Finally, we repair and tighten the diaphragm opening.
If your hernia is large or the muscle is especially weak or damaged, we may use mesh to fortify the area and help prevent the hiatal hernia from recurring.
Call Dennis L. Streeter, DO, FAAOS, today to schedule a consultation, get help for symptoms, and learn if you may need hiatal hernia surgery.
