Understanding Hiatal Hernia

What exactly is hiatal hernia?

Hiatal hernia, also known as the herniated stomach, is the protrusion of part of the stomach into the chest cavity through the diaphragm. A more serious problem, called gastric volvulus, occurs when the herniated stomach twists causing obstruction and strangulation. We have had patients who have their entire stomach herniated into the chest and completely twisted.

Why is it dubbed the great mimic? 

Hiatal hernia has often been called the “great mimic” because its symptoms can resemble many disorders. Chest pain or discomfort can sometimes be mistaken for a heart attack or muscle pain. Chronic cough and aspiration can sometimes be attributed to asthma or bronchitis.

Symptoms can vary. Patients may be asymptomatic or have vague symptoms of intermittent pain in the upper central region of the abdomen and fullness after meals with reflux disease. Large hiatal defects tend to present themselves with symptoms of progressive intolerance to solids/liquids accompanied by nausea and vomiting. They can also present with symptoms such as chest pain and respiratory problems caused by lung compression. These respiratory issues may include shortness of breath, asthma, and bronchitis. Some patients present with gastro-intestinal bleeding.

Are certain people at greater risk to develop a hiatal hernia? 

Obese people are more at risk, but it can occur even in thin people. Patients are typically female and elderly, usually in or beyond their sixth decade of life.

Can certain lifestyles or habits cause a herniated stomach?

Anything that increases pressure in the abdomen can increase the risk of developing a hernia. So, for example, heavy lifting, frequent or hard coughing/sneezing, or even vomiting are all activities that increase abdominal pressure.

How dangerous is it to ignore a herniated stomach?

Long-term effects can include development of severe reflux, aspiration into lungs, change in the lining of the esophagus (food pipe), and an increased risk of developing esophageal cancer. Large hiatal hernias can twist, leading to obstruction or strangulation, which can even lead to death.

When should I seek treatment?

Patients with increasing or unexplained symptoms (increasing abdominal fullness, reflux symptoms or inability to tolerate food) should seek medical evaluation.

What is the treatment?

Patients with large hernias and twisted stomachs need surgery to both treat the symptoms and also to prevent serious complications. Historically, hernias were treated by major operations, but in the last decade, most of these operations have been done by  laparoscope, which is quicker, causes significantly less pain and often leads  to a faster recovery. (Most patients stay one night in the hospital after surgery and are back to their normal activities in seven to 10 days.)

These are complex procedures requiring careful attention to detail and coordination with other members of the team including gastroenterologists, anesthetists and internal medicine physicians. Westchester Medical Center has been performing these complex hernia procedures for a long time. So we have an experienced team familiar with managing these complex patients. •