Diaphragm and Hiatal Hernias

At CHI Health, our experienced surgical team understands the complexities of diaphragm and hiatal hernias, which occur when weaknesses or openings in the diaphragm allow abdominal organs to enter the chest cavity. Whether these conditions have developed gradually, resulted from trauma, or are present from birth, our team has the advanced knowledge and innovative techniques to provide comprehensive diagnosis and personalized treatment, ensuring you receive the highest standard of care for optimal outcomes.

What is the difference between a hiatal hernia and other diaphragm hernias?

Both types of hernia involve the diaphragm. At the middle of the diaphragm, there is a natural opening where the esophagus travels between the mouth and the stomach. Hiatal hernias happen when this opening is big enough to allow a portion of the stomach to travel above the diaphragm. Sometimes this opening only allows a small portion of the stomach to pass through only some of the time (sliding hernia) while other times, the opening is large enough to allow the entire stomach (and sometimes other organs) to pass through into the chest.

Diaphragm hernias are weaknesses or openings in other parts of the diaphragm. They are more commonly related to injuries, birth defects, or previous surgeries. Organs that pass through these weaknesses or openings depend on the location of the hernia.

What symptoms do hiatal hernias cause?

Many patients have no symptoms from small hiatal hernias. The most common symptoms are related to gastroesophageal reflux disease (GERD). These symptoms include:

• Heartburn - a burning sensation in the chest or throat
• Regurgitation - food or liquid that spontaneously comes back up into the esophagus
• Chest pain - this pain can often be confused for pain related to the heart (angina)
• Difficulty swallowing - feeling like food or liquids get stuck or hung-up when swallowing

It is important to know that not every patient with GERD has a hiatal hernia and not every patient with a hiatal hernia has GERD symptoms.

What are the complications of hiatal hernias?

• Esophagitis - acid reflux can cause irritation to the lining of the esophagus
• Esophageal stricture - inflammation and scarring from acid can cause a narrowing in the esophagus
• Barrett’s esophagus - chronic inflammation of the esophagus can lead to changes in the cells that line the esophagus - this is a precancerous condition
• Gastritis - acid can also cause irritation to the lining of the stomach that is in the hernia
• Gastric volvulus - this is rare but means the stomach in the hernia has twisted or kinked causing a blockage of the stomach and sometimes the blood supply to the stomach

How do I know if I have a hiatal hernia?

There are a variety of tests that can show a hiatal hernia including:

• Esophagram - An x-ray study where you swallow contrast in front of an x-ray machine to show the esophagus and stomach
• Upper endoscopy - Under sedation, a flexible camera (endoscope) is maneuvered through the esophagus, stomach, and beginning of the small intestine
• CT scan - A type of specialized x-ray that takes multiple pictures from multiple directions to create a very detailed view of the body

When should I consider surgery for my hiatal hernia?

Some patients with hiatal hernias never have symptoms. However, for patients with symptoms from their hernia, you should consider talking to an expert surgeon in the following scenarios:

• You have symptoms that are not controlled by medications
• If the medications you take for your symptoms are causing side effects
• If your BMI is greater than 35 and are interested discussing an operation that can help with reflux and weight loss
• If you’d like to learn more about hiatal hernias and the options for repair

What is involved in hiatal hernia repair surgery?

Our expert surgeons repair hiatal hernias using minimally invasive surgical techniques with laparoscopy or robotic surgery. Generally, surgery to fix these hernias involves two steps:

1. Fixing the hernia - This involves pulling the stomach back down into the abdomen and making the opening in the diaphragm to be the right size for only the esophagus to pass through.
2. Performing an anti-reflux operation - This portion of the procedure is tailored to the patient based on a variety of factors including the strength of their esophagus. It involves creating a speed bump or one way valve between the stomach and esophagus to allow safe swallowing, but prevent acid from passing from the stomach up into the esophagus.

What is recovery like after hiatal hernia repair?

Most patients spend one night in the hospital after surgery and are discharged the following day as long as they are meeting their goals for discharge. These goals include good pain control and being able to drink enough to stay hydrated and get nutrition.

There are two main restrictions after surgery: no heavy lifting or rigorous activity and staying on a modified diet. After surgery, there is expected swelling of the esophagus and stomach which can temporarily make swallowing more difficult. To avoid difficulty swallowing, patients go home on a liquid diet and are gradually advanced back to a regular diet. This can take up to 6-8 weeks after surgery.

If you or a loved one have a hiatal hernia that is bothersome, CHI Health’s hernia experts are here to help. Please call to schedule a consultation.