• Dr. Jitesh Parmar

Giant Hiatus Hernia Surgery

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Introduction


A hiatus hernia occurs when a portion of the stomach protrudes through the diaphragm into the chest cavity. The diaphragm, a muscle that separates the chest and abdominal cavities, normally has a small opening (hiatus) through which the esophagus passes before connecting to the stomach. When this opening becomes enlarged or weakened, the stomach can push through, leading to a hiatus hernia.
Hiatus hernia types:

  • (1) Sliding Hiatus Hernia :  The stomach and lower oesophagus slide up into the chest through the hiatus.
  • (2) Paraesophageal Hiatus Hernia :  A part of the stomach pushes up beside the oesophagus. This type is less common but can be more serious.
  • (3) Giant Hiatus Hernia :  A very large hernia where entire portion of stomach as well as some other organs like bowel or spleen protrudes through the hiatus into chest cavity.

Causes and Risk Factors


The exact cause of hiatus hernias is not always clear, but contributing factors include:

  • Age-related weakening of the diaphragm
  • Increased pressure on the abdomen from obesity, pregnancy, heavy lifting, or persistent coughing
  • Genetic predisposition
  • Trauma or injury to the diaphragm

Symptoms


Many people with a hiatus hernia experience no symptoms. However, when symptoms occur, they are often associated with gastroesophageal reflux disease (GERD) and may include:

  • Heartburn
  • Regurgitation of food or liquids
  • Difficulty swallowing
  • Chest or abdominal pain
  • Feeling full quickly after eating

In severe cases, especially with paraesophageal hernias, complications such as strangulation of the stomach or obstruction may occur, requiring urgent medical attention.

Diagnosis


Hiatus hernias are typically diagnosed using the following methods:

  • Barium Swallow X-ray : Discomfort is usually felt in the upper right quadrant, just under the ribs. In some cases, pain may extend to the upper left quadrant if the pancreas is involved.
  • Endoscopy : Pain can radiate to other parts of the body, most commonly the back, and may sometimes be mistaken for kidney stones.
  • Oesophageal Manometry : Yellowing of the skin and eyes may occur due to bile duct obstruction.
  • pH Monitoring : Some patients describe intense gas pains or discomfort resembling post-exercise muscle ache.
  • Frequently CT scan of chest and abdomen is also required in case of a Giant Hiatus hernia.

Treatment Options for Giant Hiatus Hernia (GHH) Repair


Surgical Treatment

Surgery is recommended for individuals with severe symptoms, complications, or paraesophageal hernias at risk of strangulation. Common surgical procedures include:
Almost all GHH can be repaired with laparoscopic (Key hole) surgery with 5 small incision sin upper part of abdomen. In very rare case an open operation may be required.
During the operation stomach is repositioned in the abdominal cavoty and hiatus hernia is repaired with sutures, sometime a mesh is also required.
GHH repair is a complex major operation with significant risks associated.

Schedule a Consultation

If you suspect you have a hiatus hernia, we encourage you to schedule an appointment. Mr Parmar will provide a comprehensive evaluation and discuss the most suitable treatment options for your condition.