Hiatal hernia, also known as hiatus hernia, is a prevalent condition, with millions of cases diagnosed every year. It is a condition characterized by weakness or tear in the walls of surrounding organs, resulting in the protrusion of affected organs. Selecting the right hiatal hernia specialist is essential to ensure accurate diagnosis, management, and outcomes. Dr. Kapil Agrawal, one of the best hiatal hernia specialist in Delhi, India, is well known for his personalized care, utilizing the most advanced surgical techniques, prioritizing patient care, and ensuring the best outcomes. This article provides comprehensive insights into hiatal hernia, its causes and symptoms, and the best treatment options, including laparoscopic hiatal hernia repair.
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What is a hiatal hernia?
A hiatus hernia occurs when a portion of the stomach in the abdomen migrates into the chest cavity through a muscular layer called the diaphragm.
The diaphragm is a muscular layer that separates the abdomen from the chest cavity. When the normal opening present in the diaphragm becomes enlarged, the stomach migrates into the chest cavity. Hiatus hernia can be broadly classified into two types:
- Sliding hiatus hernia: Sliding hernia is a condition characterized by migration of the junction of the stomach and food pipe (esophagus) into the chest cavity. Usually, this junction is present in the abdominal cavity.
- Paraesophageal hiatus hernia: In this condition, the stomach and food pipe junction remain in the abdomen. However, the stomach leaves the abdominal cavity and migrates into the chest cavity.
Hiatal hernia symptoms:
Depending upon the size of the hiatus hernia and the severity of the disease, hiatus hernia presents with different symptoms:
- Heartburn, or pain in the chest, is the most common symptom of hiatus hernia, which occurs mainly at night.
- Sour or bitter taste in the mouth due to backflow of stomach contents after intake of meals.
- Difficulty in Swallowing due to compression of food pipe by hiatus hernia.
- Increased gas production or diaphragm irritation can cause excessive burping or belching.
- Irritation of the throat caused by acid reflux. It can also lead to hoarseness or a persistent sore throat. Read more about sore throat due to acid reflux
- Some individuals with hiatus hernia may experience nausea or vomiting.
Risk factors for the Development of Hiatal Hernia:
Several risk factors can contribute to the development of hiatus hernia. Understanding these risk factors can help individuals take preventive measures and make necessary lifestyle changes to prevent hernia development. According to Dr. Kapil Agrawal, one of the best hiatal hernia specialist surgeon in Delhi, India, one should avoid these circumstances to reduce the incidence of hiatal hernia. Some common characteristics include:
- Hiatal hernia tend to occur in old age due to muscle and tissue weakness.
- Obesity is one of the most common factors which can lead to hiatus hernia.
- Pregnancy can lead to a hiatus hernia due to increased abdominal pressure.
- Harmful lifestyle factors like smoking and constipation can contribute to the development of hernia.
- Some patients are genetically predisposed to hiatus hernia due to poor collagen tissue formation.
- Certain medical conditions, like ascites or heavy blunt trauma, can lead to the formation of a hiatus hernia.
Hiatal Hernia Diagnostic Test:
Several tests are available for diagnosing and establishing the disease’s extent and severity. Some of the most common tests for hiatus hernia include:
- Upper GI endoscopy: This procedure involves inserting a flexible scope through the mouth, allowing direct visualization of the stomach and hiatus hernia.
- Barium Swallow: The patient drinks a thick paste consisting of barium, and X-ray images are taken to see the presence of hiatus hernia
- Esophageal Manometry: This test measures the pressure in the esophagus with the help of sensors passed through the nose.
- Esophageal pH Monitoring: This test measures the esophagus’s acidity (pH) levels for 24 to 48 hours.
- Computed Tomography (CT) Scan or MRI scan: A CT scan or MRI scan can sometimes be used to identify the presence and extent of a hiatus hernia.
Best Treatment Options for Hiatus Hernia
The management of Hiatus hernia involves a combination of lifestyle modifications, medications, and surgical intervention. The management plan should be tailored to the size of the hernia, severity of symptoms, presence of complications, and patient treatment preference.
Lifestyle Modifications: Patients with small hiatus hernia and minimal symptoms can benefit from lifestyle modifications like weight loss, complete cessation of smoking, avoiding high-fat and spicy meals, wearing loose clothes, and avoiding late-night meals. They must raise the head end of the bed in order to minimise the chances of reflux during the night.
Medications: Patients with moderate symptoms can also benefit from medicines like proton pump inhibitors and H2 receptor antagonists. These medicines can certainly help alleviate the reflux symptoms and can provide relief for a long period of time. However, there are no medicines that can cure hiatus hernia.
Surgical Interventions: Patients with large hiatus hernias who do not respond to medicines or are at risk for complications are mainly considered for surgery.
Hiatal Hernia Laparoscopic Surgery:
In symptomatic patients not responding to conservative methods, laparoscopic repair of hiatus hernia is the treatment of choice.
During the laparoscopic hiatal hernia surgery, the surgeon creates four small incisions of 0.5 cm each. With the help of the telescope and long, thin, specialised instruments the surgery is performed. During this surgery, the surgeon restores the normal anatomy by bringing the stomach or the junction back into the abdominal cavity, repair of the hiatus or hole to prevent remigration and forming a wrap of upper part of the stomach around the junction of the stomach and food pipe. The process of forming a wrap is known as fundoplication. There are several types of fundoplication, and each type has its own indication depending on the symptoms and complexity of the hernia.
According to Dr. Agrawal , one of the best hiatal hernia specialist surgeon in Delhi, India, the surgery should always be performed by an expert who is well-versed in performing all types of fundoplication.
People also ask:
What are the complications of an untreated hiatus hernia?
Some of the most common complications associated with symptomatic and large hiatus hernias include Barrett’s esophagus, esophagitis, strictures, and aspiration pneumonia. Therefore, hiatus hernia should always be treated, and one must not ignore the symptoms.
What is the duration of the stay in the hospital?
Most patients are discharged within 36–48 hours of surgery.
Can hiatus hernia be cured with medicines?
Medicines can only alleviate symptoms or discomfort in a small hernia but can never cure it. The permanent cure for hiatal hernia is laparoscopic surgery, which should always be performed by hiatal hernia specialist. Hiatus hernia is a gradually progressive disease; the earlier the repair, the better the results.
How is the recovery period after surgery?
The patients can mobilise after 4-6 hours of surgery, resume normal activities within four days, and resume work after seven days.
What are the dietary precautions for hiatus hernia patients?
The patients are advised to have a liquid diet 7–10 days after surgery and then transition to a semi-solid or a pureed diet for the next 10 days. The patients are advised to take small portions, chew food properly, and avoid excessive intake of fatty foods and certain foods that are prone to cause acidity.
What are the different types of fundoplication?
Fundoplication is done to reinforce the sphincter present in the junction of food pipe and stomach and prevent the migration of stomach back into chest cavity. There are different types of fundoplication:
- Nissen Fundoplication: This is the most common type of fundoplication and involves complete wrap of the stomach around the junction.
- Toupet Fundoplication (Partial Fundoplication): In this procedure, only the back part of the stomach is wrapped around the oesophagus.
- Dor Fundoplication: In this procedure, the stomach is wrapped only in front of the esophagus.
Why choose us?
- Kapil Agrawal is one of the best hiatus or hiatal hernia specialist surgeon in Delhi, India, with a vast experience spanning 22 years.
- He has performed over 5,000 advanced laparoscopic hernia surgeries and has the expertise to deal with large and complex hernias.
- We had a multi-disciplinary team of hernia specialists, gastroenterologists, and dieticians to manage all types of hernia most proficiently.
- Our dedicated nutritionists are committed to avoiding surgeries by providing a dietary plan that would suit you best to relieve symptoms of hiatus hernia.
- Dr. Kapil Agrawal performs a complete range of hiatus hernia surgeries and has the expertise to perform different fundoplications.
- We are partnered with some of the best and most state-of-the-art hospitals in New Delhi and provide a cashless insurance facility for every type of insurance card.
- We also provide EMI facilities at zero percent interest to save individuals from the immediate financial burden.