Hernias are protrusions of vital structures into an area where they don’t belong. Hernias can occur out of the chest wall from the lungs or through the diaphragm from the abdomen. Hernias require surgery when the function of the herniated organ is compromised. The most common type of hernia to occur through the diaphragm is a hiatal hernia. This occurs when the stomach comes through the diaphragm at the “hiatus” and sits in the chest.
While small hiatal hernias may cause reflux, they may not necessitate surgery. People who are over age 50, smoke or are obese are at the highest risk for a hiatal hernia. If a vital organ such as a portion of the stomach, intestines or other abdominal organs slide up through the hiatus, this is called a para-esophageal hernia and there is usually a need for surgical intervention.
Hiatal hernias can be diagnosed in a variety ways, the most common being a barium x-ray, also known as an “upper GI study” or endoscopy. In a barium x-ray, the patient drinks a chalky fluid which coats the inside of the gut. A x-ray is then taken to define the anatomic relationship between the esophagus, stomach and the diaphragmatic hiatus. An endoscopy involves passing a flexible scope with a camera into the mouth and down the gut to examine the esophagus and stomach.
While many people are able to control the symptoms of small hiatal hernias with medication and diet modification, most larger hiatal hernias and para-esophageal hernias need to be surgically repaired. When surgery is necessary, the surgeon will reduce the contents of the hernia back into the abdomen, remove the hernia sac and close the area where the hernia was situated. This can be done by different approaches, including conventional chest and/or abdominal incisions or through the use of minimally invasive techniques. In the minimally invasive technique repair is performed with small incisions in the abdomen under video assistance (laparoscopic repair) leading to decreased post-operative pain and faster time to full recovery.
Cardiac Vascular and Thoracic Surgery Associates service patients with hiatal hernias in the Virginia, Maryland and DC areas. To schedule an appointment, please call (703) 280-5858.