HIATUS HERNIA
GENERAL INFORMATION
The gullet passes through a hole (the hiatus) in the
diaphragm on its way to the stomach. Sometimes,
tissue around the hiatus weakens, so the hiatus
stretches, and the weakened tissue bulges into the
chest. This is known as a hiatus hernia.
COMMON SIGNS AND SYMPTOMS
Often, there is heartburn. This is the acid from the
stomach backing up into the oesophagus.
Sometimes there is a feeling of regurgitation of
food. This is made worse when stooping or lying
flat, it gets better when standing.
DIAGNOSIS
- Usually the diagnosis can be made by taking a
detailed history and doing a thorough physical
examination.
- A barium swallow or barium meal is helpful.
- A gastroscopy is necessary to visualise the inside
of the oesophagus and stomach.
- Your doctor may decide to do oesophageal motility
studies too.
TREATMENT
If the hernia does not produce any symptoms, then no
treatment is necessary. If there are symptoms,
medical therapy is sometimes tried first. An
operation is usually considered if medical therapy
fails. The operation can be done with a laparoscope
or by open surgery.
PRE-OPERATIVE PREPARATION
Make sure your doctor knows what medicines you take,
especially medicines which may affect blood
clotting.
Do not eat or drink anything for 6 hours before the
operation.
OPERATION
You will be asleep for the operation. The technique
would have been discussed with you by your doctor.
The operation usually takes about 2 hours.
POST-OPERATIVE CARE
- You will be taken to a recovery room and observed.
When you are stable, you will be taken to a regular
hospital room.
- You may have a thin plastic tube in your nose for
a day or two. Your doctor will decide when to remove
it.
- The pain will be controlled with medicine.
- Your doctor will decide when you can start taking
liquids and later solid foods by mouth.
- You should be able to go home in 2 - 5 days.
HOME CARE
- Chew your food well before swallowing it.
- For the first few weeks you may feel a discomfort
in your throat or a sense of the food sticking. With
time this feeling should improve.
- Your doctor will discuss with you when you may
drive and return to work.
COMPLICATIONS
1. Problems are relatively common after a HIATUS
HERNIA REPAIR and complications do sometimes occur.
2. The most common problem is difficulty with
swallowing food. This usually settles spontaneously
but on rare occasions something active may need to
be done. Likewise there is sometimes an inability to
burp which may be uncomfortable. This frequently
settles spontaneously but occasionally something
active may need to be done.
3. It is important for you to know that when the
operation is attempted laparoscopically, it may not
always be possible to finish it laparoscopically. It
may need to be converted to an open operation. This
is not considered a complication but usually
reflects good surgical practice. However this will
entail more discomfort for you, a longer hospital
stay and longer time off work.
4. This is a major intra-abdominal procedure and
various problems and complications relating to the
stomach and gullet are possible. These include
perforation of these organs, it includes problems
with the blood supply to these organs and it
includes problems with the stomach moving up into
the chest. It is possible for other intra-abdominal
organs to be injured during the operation.
5. Intra-abdominal bleeding or bleeding in a wound
may occur. Your doctor will decide how to manage
this.
6. Infections in the abdominal wounds are infrequent
but do sometimes occur. How this is managed will
depend on your doctor.
7. Very occasionally an incisional hernia can
develop in the wound or at a port site.
8. Systemic complications like venous thrombosis and
pulmonary embolism are rare, but possible after any
operation or anaesthetic.
pil-hiatus hernia.doc/ver2/16 January 2002 |
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