Hiatal hernias typically occur later in life and cause a myriad of symptoms. Symptoms may include heartburn, nausea, vomiting, regurgitation, abdominal pain, chest pain, difficulty swallowing, bloating, belching or coughing. The term hiatal comes from hiatus )or opening), specifically the esophageal hiatus.
Normal anatomy consists of the the esophagus traversing the thoracic cavity from the mouth to the stomach. The esophagus enters the abdomen through an opening in the diaphragm called the hiatus. Protrusion, or herniation, of the stomach through the hiatus into the thorax is called a hiatal hernia.
There are different types of hiatal hernias. These range from simply involving a small portion of the stomach sliding into the thorax to having the entire stomach and other organ herniating into the chest. Small sliding hiatal hernias are fairly common and don't need to repaired if they are not causing symptoms.
Hiatal hernias are usually diagnosed on either CT scan or by an upper endoscopy procedure by a gastroenterologist. Preoperative workup often includes additional tests such as esophageal manometry. This involves testing how well the esophagus contracts. Before altering the anatomy of stomach with surgery, it is important to ensure the esophagus is contracting properly. An upper endoscopy, or EGD, may be needed to rule out other pathology within the esophagus or stomach that may alter the surgical procedure.
Surgery involves returning the stomach into the abdominal cavity from the chest, closing the opening in the diaphgram back to an appropriate size, and wrapping the top of the stomach around the esophagus. The stomach wrap is known as a fundoplication. This is done in an effort to prevent the hernia from recurring and to prevent reflux. Named for it's originator, this is known as a Nissen fundoplication.
Minimally invasive Nissen fundoplication allows for rapid recovery. Most patients are drinking liquids the same day as surgery and discharged home the following day. It is common to have mild difficulty swallowing bulkier foods in the early post-operative period.