Hiatal Hernia

What Is a Hiatal Hernia?


Hiatal Hernia, GERD, Hernia, GL Surgical, Dr Ganesh Ramalingam


“A hernia occurs when an organ or tissue squeezes through an opening in the muscle or tissue that holds it within its cavity. In some cases, the intestines may protrude through a weakened area in the abdominal wall.”

Dr Ganesh Ramalingam


Hernias occur primarily in the abdominal region, especially in the upper thigh, belly button, and groin areas. Most hernias are not immediately life-threatening but often do require surgery to prevent potentially dangerous complications.


What Happens When You Experience a Hernia? 


The most common symptom of a hernia is a bulge or lump in the affected area. For example, in the case of an inguinal hernia, you may notice a lump on either side of your pubic bone where your groin and thigh meet.


The lump might disappear when you are lying down, and it is likely more prominent when you are standing up, bending down, or coughing. You might also experience some pain and discomfort in the area surrounding the lump.


In some types of hernias, such as hiatal hernias, specific symptoms may be observed, such as heartburn, trouble swallowing, and chest pain. In many cases, hernias have no symptoms, and you may not know you have a hernia unless it shows up during a routine check-up or a medical examination for an unrelated problem.


“It’s important to recognise the signs of a hernia and to see a doctor if you suspect that you have one. An untreated hernia won’t go away by itself. A doctor can assess your hernia and recommend a suitable treatment plan for your condition.”

– Dr Ganesh Ramalingam


A hiatal hernia may develop over time, as was the case with a 61-year-old patient in Austria who had an ongoing problem with black and tarry stools.


Her condition presents the possibility of an untreated hiatal hernia, developing into gastrointestinal bleeding over the years due to a bleeding ulcer in the lower oesophagus, and why early medical intervention could be vital in managing this condition.


Is a Hernia Considered an Emergency?


In some instances, whether in children or adults, hernias may cause life-threatening complications. It is recommended that you seek emergency care if you experience nausea, vomiting, fever, or sudden pain. Early medical care can minimise symptoms. 


However, surgery is the only way to treat a hernia effectively. There are different types of surgeries available for hernia repairs, and our surgeon can advise on which one is best suited to your condition.


The prognosis for hernia repair surgery is generally good but can depend on the nature of the hernia, your symptoms, and your overall health. In some cases, the hernia may recur following repair.


What Is a Hiatal Hernia?


A hiatal hernia refers to a condition where the upper part of the stomach and oesophagus protrude past the opening (also known as hiatus) in the diaphragm into the chest cavity. This results in the stomach bulging through the diaphragm, which may lead to reflux symptoms, lung complications, and pain. 


This condition is observed to occur more frequently in patients over the age of 50.


What Causes a Hiatal Hernia?


While there are no known causes for hiatal hernia, studies have shown that people who experience injuries to the abdomen or chest may be prone to experiencing this condition. 


This could potentially be due to the damage leading to weakness in the muscle tissue, allowing the stomach to push through the diaphragm when pressure is exerted. 


Other causes of hiatal hernias may be linked to forceful coughing, heaving from vomiting, straining during bowel movements and carrying of heavy objects.


Hiatal hernias have also been linked to risk factors such as obesity, ageing, and smoking.


Are There Different Types of Hiatal Hernia?


Types of Hernias, Hiatal Hernia, Sliding Hiatal Hernia, Paraesophageal Hernia, GL Surgical, Dr Ganesh Ramalingam

There are two types of hiatal hernias:

  • Sliding Hiatal Hernia
  • Fixed (Paraesophageal) Hiatal Hernia


Sliding Hiatal Hernia


Sliding Hiatal Hernias are the most common type of hiatal hernias. The condition occurs when the bottom of the oesophagus, also known as the gullet, and the top of the stomach protrude through the hole (hiatus) in the diaphragm. The diaphragm is a muscle that separates the lungs from the abdomen. This results in the hernia sliding into and out of the chest through the hiatus.


Fixed Hiatal Hernia 


Fixed Hiatal Hernia, also known as a paraesophageal hernia, is a different type of hiatal hernia that is less common. 


A portion of the stomach pushes past the diaphragm in a fixed hernia and remains fixed in the location, resulting in a bulge. In such cases, the fixed hiatal hernia may obstruct the blood flow to the stomach, causing a possible risk or medical emergency. 


What Are the Symptoms of a Hiatal Hernia? 


Hiatal Hernia, Hernias, Symptoms of Hernias, GL Surgical, Dr Ganesh Ramalingam

Patients with hiatal hernia may not immediately present any symptoms. For those that do, common symptoms may include:

  • Heartburn, which is a burning sensation felt in the chest
  • Feelings of nausea
  • Difficulty swallowing
  • Chest pain


An obstructed hernia may lead to a blockage in the blood flow to the stomach, which can be a serious issue. You are advised to seek medical attention if you experience long periods of vomiting, pain or observe blood in your stools or black stools.


While it may seem that the symptoms of hiatal hernia are similar to that of other gastrointestinal diseases, it is difficult to diagnose the condition without further investigations. 


If you are experiencing frequent bouts of the symptoms mentioned above, consider scheduling an appointment with a medical professional for a proper diagnosis.


Can a Hiatal Hernia Cause GERD? 


Patients with a hiatal hernia can experience GERD. Gastroesophageal Reflux Disease (GERD) occurs when the stomach acid contents are regurgitated to the oesophagus, leading to symptoms such as heartburn. 


However, it is possible to have developed a hiatal hernia without GERD or GERD without a hiatal hernia. 


If you suspect that you may have a hiatal hernia, you are advised to seek medical advice for a proper diagnosis of your condition.


What Should I Avoid Eating or Doing if I Have a Hiatal Hernia?


Diet can play an essential role in controlling the major symptoms of a hiatal hernia, such as heartburn and acid reflux commonly seen in patients. 


Once diagnosed with a hiatal hernia, one will have to be very careful about their diet to ensure that the symptoms do not worsen. 


To help improve your condition and avoid aggravating your hernia, changing your diet may help. You may consider:

  • Reducing your intake of fat and choose low-fat foods wherever possible. Avoid high-fat, greasy, and fried foods.
  • Adding fibre to your diet to make your bowel movements more solid and reduce the strain on your lower body during bowel movement. Try to add only a serving of fibre at a time to prevent gas that can occur from eating excess fibre.
  • Avoiding foods and drinks known to be high in acidity. Though acidic foods are harmless and often nutritious, they can increase irritation and affect hernia patients. Avoid food and beverages such as spicy foods, vinegar, carbonated drinks, and alcohol. 
  • Avoiding food with a high sugar content. Food options such as soft drinks, candies, desserts, pastries, and cookies are high in calories yet result in less intake of nutrients and may lead to weight gain.
  • Avoid smoking.


How Is a Hiatal Hernia Diagnosed?


Hiatal hernias are usually diagnosed through a gastroscopy. In this procedure, our doctor will insert an endoscope, a long flexible tube fixed with an imaging device to view the walls of your stomach and oesophagus. 


This investigation allows our doctor to identify signs of abnormalities in your oesophageal walls and stomach lining and detect possible conditions, and take samples for investigation if necessary. 


Our doctor will also be able to see if your stomach is pulled up above your diaphragm, leading to a hiatus.


Do Hiatal Hernias Go Away on Their Own? 


A hiatal hernia does not go away without surgery. While lifestyle changes can help reduce the chances of triggering the symptoms of a hiatal hernia, such as acid reflux, patients are eventually recommended to seek surgical treatment if diet and medication do not relieve the symptoms. 


Laparoscopic Nissen Fundoplication Surgery is one of the recommended treatments for this condition. This surgery tightens and reinforces the lower oesophageal sphincter (LES), which helps prevent acid from being regurgitated into the oesophagus. 


In the procedure, the upper part of the stomach is wrapped around the exterior of the lower oesophagus to strengthen the sphincter. It is also observed to be highly successful and help improve the patient’s lifestyle in the long run.


How Is a Hiatal Hernia Treated? 


Laparoscopic Nissen Fundoplication Surgery, GERD


Hiatal hernias do not go away without surgery. However, for patients who experience mild symptoms of heartburn and acid reflux, they may be prescribed medication to manage the condition before surgery is recommended.


Medications such as antacids, H2-receptor blockers, and proton pump inhibitors are some of the options that our doctor may prescribe to help lower or neutralise the effects of stomach acid on your oesophageal walls, giving it more time to heal.


If the condition continues to worsen or becomes more frequent, surgery will be the option to treat hiatal hernia.


For Char Bucci, her 30 years of suffering from severe heartburn were fixed in one hours following a hiatal hernia surgery.


Using the Laparoscopic Fundoplication technique to treat her hiatal hernia, the doctor made incisions less than an inch compared to a 12-inch-long incision in the abdomen in open surgeries. This also ensured that Char was able to recover faster and get back to living her life.   


“Laparoscopic Nissen Fundoplication is one of the recommended treatments that we suggest to patients who have experienced long and severe bouts with GERD or hiatal hernias. It is minimally invasive so patients can generally expect a quicker recovery time and with a lower risk of complications.”

Dr Ganesh Ramalingam


Nissen Fundoplication can be performed either as an open surgery or laparoscopically. 


In both types of procedures (whether open or laparoscopic), a Nissen Fundoplication involves wrapping the upper part of the stomach around the lower oesophagus. 


This tightens the sphincter around the lower oesophagus, and makes it less likely that acid will flow back up the oesophagus.


This procedure serves to tighten and reinforce the lower oesophageal sphincter (LES) and has a high success rate in helping patients recover and prevent recurrence in the long run.


What Happens After I Treat My Hernia?


After your surgery, it is common to experience discomfort around the surgical site and even the shoulder. Our surgeon will prescribe medication to help ease this discomfort as you recover.


Tending to your wound will require extra care. You are advised to carefully follow our surgeon’s instructions to prevent complications or infections during your recovery.


Open surgery often requires a longer recovery process than laparoscopic surgery. Your surgeon will let you know when you can return to your regular routine.


Following the surgery, you will be able to move around normally, but you may be advised to avoid any strenuous activity. Additionally, you should avoid carrying and lifting heavy objects during this recovery period. This is to prevent adding stress and strain to the wounds and the operative site. 


You will likely be required to eat slowly and chew your food more thoroughly before you swallow, after surgery.


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