Hernia surgery Abu Dhabi

What is a hiatal hernia?

A hiatal hernia is a medical disorder in which the muscle separating the chest cavity from the abdomen, the diaphragm, allows a part of the stomach to push upward. Sliding hiatal hernia and paraesophageal hiatal hernia are the two primary varieties.

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Although the precise aetiology of hiatal hernias is unknown, age, obesity, pregnancy, and frequent heavy lifting are risk factors. 

 

What are the symptoms of a hiatal hernia? 

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The symptoms of a hiatal hernia can vary depending on the size of the hernia and the severity of the condition. Some common symptoms include:

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1. Heartburn and Acid Reflux: One of the most typical signs of a hiatal hernia is heartburn. It occurs because the hernia allows the stomach to move into the chest, compromising the barrier that usually prevents acid reflux.

2. Chest Pain and Discomfort: Chest pain brought on by hiatal hernias might be misinterpreted for heart-related problems like angina or heart attacks. The pain is often located behind the breastbone and may worsen after meals or when lying down.

3. Difficulty Swallowing (Dysphagia): Larger hiatal hernias can compress the oesophagus, leading to difficulty swallowing, particularly with solid foods. This feeling of food getting stuck or like a lump in the throat can be distressing.

4. Regurgitation: With a hiatal hernia, stomach contents may regurgitate into the mouth, resulting in a sour or acidic taste. This symptom is similar to acid reflux but can be more frequent and bothersome in hiatal hernia cases.

5. Belching and Abdominal Discomfort: Hiatal hernias can cause increased pressure in the stomach, leading to excessive belching and bloating. Patients may feel bloated and uncomfortable in the upper abdomen, particularly after meals.

 

What are the causes of a hiatal hernia?

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The exact cause of hiatal hernia is unknown, but there are a number of factors that can increase your risk of developing a hiatal hernia. These include:

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1. Congenital Factors: Some hiatal hernias can be present from birth due to developmental abnormalities. These congenital factors may weaken the structures around the diaphragm, making it easier for the stomach to push through.

2. Age and Muscle Weakness: As people age, the diaphragm and surrounding muscles may gradually weaken, increasing the chance of getting a hiatal hernia.

This age-related muscle weakening can weaken the diaphragmatic hiatus, the opening through which the oesophagus passes.

3. Obesity and Excess Abdominal Pressure: Excess weight and obesity can put pressure on the abdomen, leading to a higher chance of getting a hiatal hernia. This added pressure can force a portion of the stomach through the diaphragm.

4. Frequent Heavy Lifting or Straining: Engaging in activities that involve frequent heavy lifting or straining, such as weightlifting or chronic coughing, can increase intra-abdominal pressure. This pressure can contribute to the development of a hiatal hernia over time.

5. Injury or Trauma: In some cases, an injury or trauma to the chest or abdomen, such as a severe blow or accident, can weaken the diaphragm and create conditions favourable for a hiatal hernia to occur.

 

How is a hiatus hiatal diagnosed? 

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Hiatal hernias can be diagnosed with a variety of tests, including:

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1. Medical History and Physical Exam: Gathering a thorough medical history and doing a physical exam to assess symptoms and potential risk factors are the first steps in diagnosing a hiatal hernia.

2. Imaging Tests: Various imaging tests can assist in determining whether a hiatal hernia is present and how big it is. These may consist of:

3. X-rays are obtained after swallowing a liquid contrast material (barium), which allows doctors to see the oesophagus and stomach and detect any herniation.

4. Endoscopy: The oesophagus and stomach are examined using a flexible, thin tube with a camera (endoscope), allowing the doctor to see the hernia and determine any problems or inflammation.

5. Esophageal Manometry: This test analyses the pressure and coordination of the oesophageal muscles to determine how well the oesophageal muscles work and whether any malfunction may cause the hernia.

6. pH Monitoring: In cases of suspected acid reflux, pH monitoring can be performed to measure the level of acidity in the oesophagus over 24 hours.

7. Electrogastrography (EGG): This test measures the electrical activity of the stomach muscles to evaluate stomach motility and function.

8. Bravo Capsule: A small wireless device is placed in the oesophagus during endoscopy to measure acid levels and assess acid reflux over time.

 

How is a hiatus hiatal treated? 

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The course of treatment for a hiatal hernia is determined by the degree of the symptoms, the size of the hernia, whether there are any complications, and the patient's general condition. 

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1. Lifestyle Modifications: In mild cases, lifestyle changes can alleviate symptoms and reduce the impact of a hiatal hernia. These may include avoiding large meals, fatty and acidic foods, carbonated beverages, and tobacco. Keeping a healthy weight and avoiding lying down just after eating can be beneficial.

2. Medications: Over-the-counter antacids, H2 blockers, and proton pump inhibitors (PPIs) can help reduce acid reflux and alleviate heartburn associated with a hiatal hernia—these drugs function by reducing or neutralising stomach acid production.

3. Elevating the Head of the Bed: By leveraging gravity to keep stomach contents in place, raising the head of the bed by around 6 to 8 inches will help avoid acid reflux as you sleep.

4. Surgical Intervention: Surgery may be recommended for severe or symptomatic hiatal hernias that do not respond to conservative measures. The most typical treatment is called a Nissen fundoplication. In this, the upper portion of the stomach is wrapped over the lower oesophagus to strengthen it and stop reflux.

5. Endoscopic Treatments: In some cases, minimally invasive endoscopic procedures may be used to treat hiatal hernias. For instance, endoscopic sewing (endoscopic suturing) can tighten the opening in the diaphragm and reduce the hernia's size.

 

What are the complications of a hiatal hernia? 

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1. Gastroesophageal Reflux Disease (GERD): Hiatal hernias can contribute to GERD, a chronic condition where stomach acid frequently flows back into the oesophagus. Untreated GERD can lead to esophagitis (inflammation of the oesophagus) and may increase the risk of developing Barrett's oesophagus or oesophagal cancer over time.

2. Strangulation: In rare cases, the herniated portion of the stomach can become trapped or "strangulated" in the diaphragm opening. It can cut off the blood supply to the trapped tissue, causing severe pain, vomiting and potentially leading to tissue death, a medical emergency requiring immediate surgery.

3. Ulcers and Bleeding: Chronic acid reflux caused by a hiatal hernia may lead to the formation of stomach ulcers. These ulcers can bleed, leading to anaemia or black, tarry stools (melena), indicating upper gastrointestinal bleeding.

4. Respiratory Issues: Large hiatal hernias may compress the lungs, causing chronic coughing, wheezing, and shortness of breath. It occurs due to the displacement of the diaphragm and the pressure on the lungs.

5. Inflammation of the Esophagus: Chronic acid exposure from GERD may irritate the lining of the oesophagus, a condition known as esophagitis. This inflammation can cause pain and difficulty swallowing.

 

Early detection and appropriate care can reduce problems and enhance overall results.

 

What is the prognosis for a hiatal hernia?

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The prognosis for a hiatal hernia is generally favourable, especially for smaller hernias that are asymptomatic or respond well to conservative measures. Lifestyle changes, medications, and proper management can effectively control symptoms. Surgery may be necessary to resolve issues and enhance results in more severe cases. Regular check-ups and the appropriate treatment can improve the prognosis and avoid potential problems.

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Tips for Managing Hiatal Hernia:

• Follow a healthy diet, avoiding trigger foods and large meals.

• Maintain a healthy weight to reduce abdominal pressure.

• Elevate the head of the bed to prevent nighttime reflux.

• Quit smoking and limit alcohol consumption.

• Take prescribed medications as directed by healthcare professionals.

• Practice stress management techniques to avoid excessive straining.

• Attend regular check-ups and follow-up appointments with a healthcare provider.

 

How can I prevent a hiatal hernia? 

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Preventing a hiatal hernia involves adopting a healthy lifestyle and minimizing factors contributing to its development. While not all hiatal hernias can be prevented, the following tips can reduce the risk:

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• Maintain a Healthy Weight: Avoid obesity and excess weight, as they can increase abdominal pressure.

• Eat Smaller, Balanced Meals: Opt for frequent smaller meals to reduce pressure on the diaphragm.

• Avoid Trigger Foods: Limit acidic, fatty, and spicy foods that may worsen acid reflux.

• Practice Good Posture: Avoid slouching or lying down after meals to prevent pressure on the abdomen.

• Quit Smoking: Smoking weakens the lower oesophagal sphincter, increasing the risk of reflux.

• Avoid Heavy Lifting: Minimize activities that involve frequent heavy lifting or straining.

• Manage Chronic Cough: Seek treatment for persistent cough, which can increase abdominal pressure.

• Control GERD: If diagnosed with GERD, follow a treatment plan to minimize reflux and complications.

 

What should I do if I think I have a hiatal hernia? 

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If you suspect you have a hiatal hernia or experience symptoms like heartburn, chest pain, or difficulty swallowing, seek medical attention promptly. Your disease can be thoroughly evaluated, diagnosed, and treated following the recommendations of a healthcare professional.