Hiatus Hernia

What is a hiatus hernia?

The chest and abdominal cavities are separated by a large flat muscle called the diaphragm and the most common type of hiatus hernia occurs where the oesophagus (gullet) passes thought the diaphragm on its way to the stomach. The opening where the oesophagus passes through the muscle fibres of the diaphragm sometimes becomes enlarged allowing a pouch of the stomach to slide upwards and become trapped. The majority of hiatus hernias are initially small but if left untreated they can become large and occasionally the whole stomach (and other abdominal organs) can slide up into the chest cavity.

What are the symptoms of hiatus hernia?

A small hiatus hernia may be symptom free and even fairly large ones are sometimes only picked up on routine X-ray. However, classic symptoms of hiatus hernia are:

• Bloating
• Belching
• Nausea
• Chest pain (sometimes mistaken for heart attack)
• Heart burn
• Palpitations
• Difficulty in swallowing
• Vomiting
• Regurgitation of food
• Shortness of breath

What is the treatment?

Small hiatus hernias are usually treated conservatively (without surgery) with dietary measures (small frequent meals), weight reduction and drugs. However, larger hernias generally require surgical repair. An endoscopy (camera examination) and certain X-rays are usually performed pre-operatively. Repair of a hiatus hernia is a common operation that can be performed either through an upper abdominal incision or via a laparoscope (key-hole surgery). The laparoscopic approach has become more and more common over the past few years and generally has very good results. The sac of the hernia is pulled back down into the abdominal cavity and the defect in the diaphragm is repaired with an artificial mesh. This mesh is perfectly safe and has been used in surgical procedures for many years.

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