What Is a Hiatal Hernia?
A hiatal (hiatus) hernia is a condition where a section of the stomach bulges through one’s diaphragm into the chest cavity.
What Are the Types of Hiatal Hernias?
The main types of hiatal hernia include:
Sliding Hiatal Hernia
: This is the more common type, where the stomach and the lower part of the oesophagus slide up into the chest through the hiatus. Sliding hiatal hernias are usually asymptomatic. However, they may be a risk factor for GERD, as the stomach's position can cause the valve between the oesophagus and stomach to malfunction.Paraesophageal (Rolling) Hiatal Hernia
: Less common but potentially more serious, a paraesophageal hernia occurs when part of the stomach pushes through the hiatus and sits next to the oesophagus. Paraesophageal hernias carry the risk of the stomach having its blood supply cut off. Thus, immediate medical attention is required.What Are the Common Signs & Symptoms of a Hiatal Hernia?
Some people may not experience any symptoms, especially in the early stages. Symptomatic hernias often present symptoms related to GERD. These symptoms include heartburn, regurgitation of food or liquids into the mouth, trouble swallowing, abdominal or chest pain, and feeling full soon after eating.
Symptoms for strangulated hernias include severe chest or abdominal pain, vomiting, persistent upset stomach, and difficulty passing gas. If you experience these symptoms, consult your hernia specialist immediately.
Unsure if you might have a hiatal hernia? Make an appointment with Dr Wong at 62354088 for a detailed assessment today.
What Are the Causes & Risk Factors for a Hiatal Hernia?
The exact cause of hiatal hernias remains unknown. However, it is believed to be linked to the weakening of muscle tissue from injury or other forms of damage, allowing the stomach to push through the diaphragm. Other contributing factors include:
- Weakening of the diaphragm with ageing
- Injury to the area
- Being born with an unusually large hiatus
- Chronic coughing
- Repetitive vomiting
- Excessive straining during bowel movements
- Exercising or lifting heavy objects
How Is a Hiatal Hernia Diagnosed?
Hiatal hernias are often diagnosed using specialised tests that assess the structure and function of the oesophagus and stomach. These diagnostic procedures help confirm the presence of a hernia and determine its severity. Common tests include:
- Upper Endoscopy (Gastroscopy): A diagnostic endoscopy is usually used to diagnose hiatal hernias. It involves inserting a tube with a camera (endoscope) down the throat to view the oesophagus and the stomach.
- X-ray and Barium Swallow Test: A barium swallow test involves drinking a chalky liquid (barium) and taking an X-ray of one’s upper digestive system to detect the presence of hernias. This test has a high diagnostic accuracy for detecting hiatal hernias, especially when symptoms like reflux or swallowing difficulties are present.
- Oesophageal Manometry (Motility Test): An oesophageal manometry involves inserting a thin, flexible tube with high-resolution pressure sensors through the nose into the oesophagus. Patients swallow small amounts of liquid during the test, allowing the device to assess swallowing coordination and muscle function.
Hiatal Hernia Treatment Options Singapore
Hiatal Hernia Non-Surgical Treatments
Managing a hiatal hernia without surgery requires a combination of medications, dietary adjustments, and lifestyle changes. While these methods do not reverse the hernia itself, they help control symptoms.
- Medications: Medications to treat hiatal hernia symptoms, such as antacids, H2 blockers, and proton pump inhibitors, are often used to manage symptoms like heartburn and acid reflux associated with hiatal hernias. While these do not cure the hernia, they can help relieve symptoms.
- Dietary Modifications: Implementing certain lifestyle changes can prevent acid reflux and improve overall digestive health. These typically include meal adjustments, food choices, and weight management.
- Lifestyle Changes: Discomfort can be reduced by quitting smoking, wearing comfortable clothing, and raising the head of your bed by 15–20 cm to help prevent acid reflux.
Hiatal Hernia Surgical Treatments
Due to the structural nature of a hiatal hernia, the stomach cannot be repositioned through medication, diet, or exercise. Surgery remains the sole definitive treatment.
- Laparoscopic (Minimally Invasive) Hiatal Hernia Surgery: Laparoscopic surgery is a modern surgical technique that allows doctors to operate with minimal incisions. This method offers patients a faster recovery, reduced pain, and a lower risk of complications compared to traditional open surgery.
- Nissen Fundoplication: This is a surgical procedure that aims to reduce reflux caused by a hiatal hernia. During surgery, the top of the stomach is wrapped around the lower oesophagus to strengthen the valve between the oesophagus and the stomach. This may be performed laparoscopically or as an open surgery. The whole procedure typically takes 1–2 hours.
- Open Surgery: In more serious cases, open hiatus hernia surgery might be needed to reposition the stomach and make the opening in the diaphragm smaller. This is usually reserved for larger or more complicated hernias.
- Endoluminal Fundoplication (ELF): ELF is a less invasive procedure for hiatal hernia performed through the mouth. It utilises specialised tools to create a partial fold at the top of the stomach. This helps to prevent stomach acids from flowing back into the oesophagus.
When Will Surgery Be Needed for a Hiatal Hernia?
Hiatal hernia surgery is typically considered when the hernia is large or of the paraesophageal type, which can increase the risk of complications like strangulation or obstruction.
Additionally, surgery may be needed in cases where symptoms do not respond to conservative treatments and become more severe and frequent.
What to Expect Before a Hiatal Hernia Operation
To ensure a smooth hiatal hernia surgery and recovery, patients must prepare properly. Your doctor will give you specific instructions based on your health. Generally, you will be advised to:
- Fast for about 8–12 hours before surgery
- Avoid alcohol and caffeine for at least one week before surgery
- Follow your doctor's medication instructions before surgery
- Stop smoking at least two weeks before surgery
- Engage in light exercise, like walking
Recovery After Hiatal Hernia Surgery
After hiatal hernia surgery, you will be monitored in the recovery room while the effects of anaesthesia wear off. Your doctor will check for complications like difficulty swallowing, excessive pain, or nausea. Mild to moderate incision site pain is common and can be managed with pain relievers. For a smooth recovery, follow your doctor’s instructions carefully.
Recovery time depends on the surgical approach. Compared to open surgery, laparoscopic surgery generally allows for a quicker return to light activities and non-strenuous work. A follow-up appointment is usually scheduled shortly after surgery, with possible additional check-ups.
Let us tailor the most effective solution for your hiatal hernia.Contact our specialist clinic at 62354088 for a personalised treatment plan.
Why Choose Us for Hiatal Hernia Surgery
Dr Wong Jen San is a skilled Consultant Hepatobiliary and Pancreatic Surgeon with over 15 years of experience treating hernias, including the use of minimally invasive (laparoscopic) techniques for improved patient outcomes.
Dr Wong received his medical training from the University of Leicester in the UK, and completed his rigorous fellowship training at Kyoto University Hospital and Kumamoto University Hospital in Japan.
Prior to setting up his practice, he was a Consultant at the Department of Hepatopancreatobiliary (HPB) and Transplant Surgery at the Singapore General Hospital, an Adjunct Assistant Professor at Duke-NUS Graduate Medical School, and a Visiting Consultant at the Department of Surgical Oncology at the National Cancer Centre (Singapore).