Tip:
Highlight text to annotate it
X
A hiatal hernia occurs whenever the junction between your esophagus, which is your food
tube, and your stomach, where the food sits in your abdomen, slips up into your chest.
So normally that junction sits right at your diaphragm. The valve there keeps gastric fluid,
the high acidity of your stomach, from coming up into your esophagus. There are multiple
different types of hiatal hernias. In a sliding-type hiatal hernia, which is the most common type,
the junction slides into the esophagus. In a pera-esophageal hernia, meaning beside the
esophagus, the stomach actually flips up alongside the esophagus and that's a little more concerning
because the stomach can become trapped up there.
What are the symptoms of a hiatal hernia? Oftentimes, a hiatal hernia has no symptoms
and doesn't require any treatment. If you have a very large hiatal hernia, a large amount
of your stomach can get trapped up in your chest. They are often associated with reflux
or heartburn, where you have acid that normally stays in your stomach that comes up into your
esophagus and causes that burning sensation or that chest pain sensation that you get
with heartburn.
What are the treatments for a hiatal hernia? The vast majority of hiatal hernias don't
require surgical treatment. Most of the time patients have reflux and our medications for
treating heartburn are excellent. Surgery is reserved for special cases of hiatal hernias
or reflux, that is either nonresponsive to the medications or in very young patients
who don't want to take these medications for their whole life.
What are the surgical options? The surgical options usually can be a laparasopic
or robotic approach. Both use multiple small incisions on the abdomen. It's usually up
to the surgeon's preference as to which approach is used. We put the junction of your stomach
and your esophagus back down in your stomach in your abdomen where it belongs. We usually
perform some type of anti-reflux surgery where we try to recreate the valve at the junction
so you won't have the continuous reflux. What are the advantages of robotic surgery?
The advantage of the da Vinci is the platform is very stable. The robotic arms are doing
the movement. The movements are a little more precise and it makes doing the suturing technically
more easy. They have been using the robot for hiatal hernias for about two years.
What can a patient expect? Usually the outcomes are excellent. There
is a risk of bleeding and infection, just like there is with any surgery that we do.
Patients get antibiotics at the time of surgery to prevent that. There is a risk of injuring
the esophagus or the stomach when we're trying to get it clear of these dense connections
that are around it. Rarely patients will have difficulty swallowing afterwards because when
we're trying to recreate the valve that's loose down there or if you have a lot of swelling
after surgery you can have some difficulty swallowing after surgery.
Most patients can expect from relief from the chest pressure and the vast majority of
patients don't require any further medications for their reflux symptoms. About 20 percent
of patients unfortunately do have to go back on their medications for reflux, but 80 percent
of patients do not. How long is the recovery?
Usually for a hiatal hernia repair the patients are kept overnight. We make sure they can
swallow liquids well the next day. As with other laparscopic surgeries, we don't let
patients lift any *** Most patients can return to work in about a week. Sometimes patients
need to be on a softer diet for a few weeks after the repair.
How common are hiatal hernias? They are very common -- probably 30 percent
of Americans have a hiatal hernia. The vast majority have no sysmptoms. Those with symptoms
can oftentimes be treated with medications. Surgical treatment is reserved for patients
who have failed medical therapy or who have complications or can't tolerate taking the
acid-controlling medicines.