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Hiatus Hernia

The most common type of hiatal hernia is a sliding hiatal hernia. This accounts for
95% of all hiatal hernias and, because a hiatal hernia by itself causes no symptoms,
it is unknown how frequently this condition exists in the general population. With a
sliding hernia, the GE junction and a portion of the stomach slides upward into the
mediastinum, the space in the chest between the lungs where the esophagus
travels and where the heart is housed. The hernia is more prominent during
inspiration when the diaphragm contracts and descends towards the abdominal
cavity and when the esophagus shortens during swallowing.

What are the signs and symptoms of a hiatal hernia?

By itself, a hiatal hernia causes no symptoms, and most are found incidentally when
a person has a chest X-ray or abdominal X-rays (including upper GI series, and CT
scans, where the patient swallows barium or another contrast material). It also is
found incidentally during gastrointestinal endoscopy of the esophagus, stomach and
duodenum (EGD).
Most often if symptoms occur, they are due to gastroesophageal reflux
disease (GERD) where the digestive juice containing acid from the stomach moves
up into the esophagus.

How is a hiatus hernia diagnosed?

A hiatus hernia can be diagnosed with endoscopy, where a camera on the end of a
tube is inserted through the mouth and down into the stomach.
Another method is the barium meal X-ray, where a special chemical is drunk and
then x-rays are taken to give a clear image of the hernia.
How are hiatus hernias treated?
Treatment is only needed if the hiatus hernia is causing problems.
Lifestyle changes or medicine may be recommended for the symptoms of GORD.
If these haven’t worked, keyhole surgery may be recommended for sliding hiatus
The surgical procedures available are:
Laparoscopic nissen fundoplication (LNF) to put the stomach back into its correct
position and to tighten the diaphragm.
Para-oesophageal hiatus hernia may be needed to reduce the risk of the hernia
becoming strangulated.