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Hiatal Hernia

Posted Jun 02 2009 4:39pm

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 (food pipe) goes through the hiatus and attaches to the stomach. In a hiatal hernia (also called hiatus hernia) the stomach bulges up into the chest through that opening.

There are two main types of hiatal hernias: sliding and paraesophageal (next to the esophagus).

Sliding Hiatal Hernia
In a sliding hiatal hernia, the stomach and the esophagus slide up into the chest through the hiatus. This is the more common type of hernia.

Paraesophageal Hernia
The paraesophageal hernia is less common, but is more cause for concern. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus. Although you can have this type of hernia without any symptoms, the danger is that the stomach can become "strangled," or have its blood supply shut off.

Often, people with hiatal hernia also have heartburn or GERD. Although there appears to be a link, one condition does not seem to cause the other, because many people have a hiatal hernia without having GERD, and others have GERD without having a hiatal hernia. People with a hiatal hernia may experience chest pain that can easily be confused with the pain of a heart attack. That's why it's so important to undergo testing and get properly diagnosed.

Causes
Most of the time, the cause is not known. Some people develop a hiatal hernia after sustaining an injury to that area of the body; others are born with a weakness or an especially large hiatus. Some experts suspect that increased pressure in the abdomen from coughing, straining during bowel movements, pregnancy and delivery, or substantial weight gain may contribute to the development of a hiatal hernia.

Risk factors
In addition to the increased occurrence in people over 50, hiatal hernias also occur more often in overweight people (especially women) and smokers.

Diagnosis
A hiatal hernia can be diagnosed with a specialized X-ray study that allows visualization of the esophagus (barium swallow) or with endoscopy.

Treatment
Most people do not experience any symptoms of their hiatal hernia so no treatment is necessary. However, the paraesophaeal hernia (when part of the stomach squeezes through the hiatus) can cause the stomach to be strangled so surgery is usually recommended. Other symptoms that may occur along with the hernia such as chest pain should be properly evaluated. Symptoms of GERD should be treated.

If the hiatal hernia is in danger of becoming constricted or strangulated (so that the blood supply is cut off), surgery may be needed to reduce the hernia, meaning put it back where it belongs.

Hiatal hernia surgery can be performed as a laparoscopic, or "minimally invasive," procedure. During this type of surgery, five or six small (5 to 10 millimeter) incisions are made in the abdomen. The laparoscope and surgical instruments are inserted through these incisions. The surgeon is guided by the laparoscope, which transmits a picture of the internal organs to a monitor. The advantages of laparoscopic surgery include smaller incisions, less risk of infection, less pain and scarring, and a more rapid recovery.

Many patients are able to walk around the day after hernia surgery. Generally, there are no dietary restrictions and the patient can resume his or her regular activities within a week. Complete recovery will take 2 to 3 weeks, and hard labor and heavy lifting should be avoided for at least 3 months after surgery. Unfortunately, there is no guarantee, even with surgery, that the hernia will not return.

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