Hernia is an opening formed by the lining of the abdominal cavity. Abdominal wall hernia occurs when the contents of the intestine bulges out of the abdominal wall. Hernias are developed at birth (congenital) or may appear later (acquired).
Hernia may be present at birth and occurs when the lining around the abdominal organs fails to close before birth. Hernia may also result if the connective tissue degenerates in the abdominal wall due to which pressure builds up in the abdominal wall leading to a bulge in the abdomen. Some of the other factors that worsen hernia are chronic cough, obesity, constipation, pregnancy, poor nutrition, smoking and stretching or straining abdominal muscles while lifting heavy objects.
Normally, the stomach is completely below the diaphragm. In individuals with hiatus hernia, part of the stomach slides through the diaphragm, the muscular sheet that separates the lungs and chest from the abdomen and protrudes into the chest cavity. Hiatal hernia is more common and affects people of all ages.
Hiatal hernias are of many types. They can be sliding hiatal hernias where the oesophagus and the stomach move up. They can be rolling hiatal hernias where the stomach itself rolls up or a mixed hiatal hernia or a complex hiatal hernia. They can be of varying sizes from very small 1 centimetre size right up to the whole stomach being in the chest.
Obesity, chronic cough, chronic constipation, smoking, and hereditary factors increase the risk of developing hiatal hernias. Hiatal hernia may not cause any symptoms but patients may experience chest pain, heart burn, belching, and hiccups.
Your doctor can confirm the presence of hernia by performing a physical examination. A special X-ray (using a barium swallow) will be ordered that allows your doctor to view the oesophagus or by performing endoscopy.
Surgery is the best treatment for hiatal hernias as they can increase in size over time. The concern is not only worsening symptoms but that the stomach can get entrapped in the chest and have a restricted blood supply which may affect the blood supply to the stomach and therefore ischaemia.
Hiatal hernia repair is usually performed as a keyhole operation with a one night stay in hospital.