All About Hiatal Hernias

Hiatal hernia repair surgery often requires the use of mesh. When the mesh causes injuries, you may be eligible to file a claim or sue for compensation.

Like all hernias, hiatal hernias occur when part of the internal tissue or organ is pushed through an opening into part of the body where it doesn't belong. In the case of hiatal hernias, a section of the stomach is pushed up into the chest. This type of hernia can range from very mild to severe, and does not always require surgery. In fact, up to 60% of people will develop hiatal hernias to some degree by the age of 60. 1

Hiatal hernias may not always be as serious as other types of hernias; however, they do require sustained attention and care. To learn more about the symptoms, risks, and treatment options for this type of hernia, read on.

Hernia mesh operating room
Hiatal hernia repair surgery often requires the use of mesh. When the mesh causes injuries, you may be eligible to file a claim or sue for compensation.

1. What is the anatomy of the hiatal hernia?

Between the stomach and the esophagus, there is an opening in the diaphragm called the “esophageal hiatus.” This opening is usually only large enough to allow the esophagus to connect to the stomach. However, when the hole becomes weakened or enlarged, the stomach tissue can bulge up into the diaphragm. Unlike other hernias, the bulge will not appear outside of the body.

2. Are all hiatal hernias the same?

There are two main types of hiatal hernias.

A sliding hiatal hernia occurs when the junction between the esophagus and the stomach slides up during moments of pressure. In general, during moments of calm, the hernia will return to its normal position due to gravity. This hernia is caused by the general weakness of the tissues that hold this junction in place. They are most common in those who are

  • Smokers
  • Overweight
  • Women over 50.

A paraesophageal hiatal hernia is when the junction between the esophagus and the stomach stays in place. However, a part of the stomach slips through the opening into the chest. These hernias are generally more serious than sliding hiatal hernias because the tissue can be caught.

3. What are some symptoms of hiatal hernias?

Hiatal hernias rarely show any symptoms. In most cases, the only symptom will be chronic heartburn because acid from the stomach is pushed into the esophagus. The heartburn may worsen when the patient

  • Leans forward
  • Strains their abdominal muscles through lifting or coughing
  • Lies down

Other symptoms of hiatal hernias may present as

  • Burping
  • Hiccups
  • Nausea, regurgitation, vomiting, or dry heaving
  • Chest pain and/or burning
  • Abdominal pain
  • Difficulty swallowing
  • Black stool
  • Coughing spasms, asthma, or repeated lung infections

4. What risks are involved with this hernia?

Hiatal hernias can range from asymptomatic (no symptoms) to severe and life-threatening. In particular, sliding hiatal hernias may be present for years with no impact on an individual's health or quality of life. In fact, fewer than 5% of hiatal hernias require surgery. However, in the case of a paraesophageal hernia, the hernia is more likely to become

  1. Incarcerated, in which the fold of the stomach is trapped permanently in the chest cavity, or
  2. Strangulated, in which the blood supply is cut off from the herniated portion of tissue. This can cause permanent tissue death if left untreated.

Incarcerated and strangulated hiatal hernias will usually cause more significant and pressing pain for the patient, and should be treated immediately.

In addition, hiatal hernias may cause anemia due to chronic bleeding around the area of the esophagus. Anemia is a decrease in the level of red blood cells in the body and can cause fatigue, headaches, and chest pain.

5. How are hiatal hernias diagnosed?

Sometimes, hiatal hernias are discovered by accident by a physician when checking for other conditions. Or, a doctor may suspect your hiatal hernia and perform one of the following:

  • Chest x-ray
  • Esophagoscapy: camera inserted into the esophagus
  • Barium swallow: patient swallows dye which will appear on the x-ray to show the outline of the stomach and possible hernia
  • Esophageal manometry: a test uses a tube inserted into the esophagus to measure the functioning and pressure of the connection between the esophagus and the stomach 2

6. What are possible treatment options?

If the hernia patient is exhibiting no symptoms, treatment is not usually recommended. If symptoms are mild, prescription medication is usually given to manage pain and discomfort, such as

  • Antacids: neutralize stomach acid
  • H-2 receptor blockers: reduce stomach acid production
  • Proton pump inhibitors: stronger medications which also reduce stomach acid production for long enough to allow the esophagus to repair itself 3

In the case of a strangulated or incarcerated hernia, surgery is often required. Additionally, surgery becomes an option if a hiatal hernia is causing significant and persistent pain that cannot be managed with medication.

7. What are the surgical options?

If surgery is required, there are multiple options available, depending on the characteristics of the patient's hernia. The surgeon may advise

  • Open surgery, in which a single large chest incision is made, or
  • Laparoscopic surgery, in which four small incisions are made around the hernia and surgical instruments are manipulated inside of the body with the use of a fiber optic light and camera

The physician will pull the stomach back into the abdomen, remove or repair the hernia sac, and possibly reconstruct the esophageal sphincter. In certain cases, hernia repair mesh may be used.

8. What complications are associated with surgery for hiatal hernias?

Like all surgery, hiatal hernia repairs pose an array of possible complications. The use of mesh in paraesophageal hiatal hernia repair is controversial because it is connected to complications such as

  • Erosion of mesh into the esophagus or gastric cardia (upper stomach)
  • Esophageal stenosis (difficulty breathing)
  • Dysphagia (difficulty swallowing)
  • Mesh infections.

If your surgeon chooses to use mesh, they should communicate all risks associated with the product to you before your surgery. 4

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9. When should I contact a medical malpractice attorney?

A medical malpractice attorney can help you evaluate your particular case and decide if a lawsuit for hernia mesh injuries may help you move forward. If you are experiencing complications from a hiatal hernia repair surgery, especially if hernia repair mesh was utilized, speaking with a personal injury attorney may be in your best interest.

References

  1. Simic, John P. Hiatal Hernia. emedicinehealth.
  2. Harvard Health Publishing. Hiatal Hernia. October 2014.
  3. Mayo Clinic. Hiatal Hernia.
  4. Lebenthal, Abraham, Stephen D. Waterford, and P. Marco Fisichella. Treatment and Controversies in Paraesophageal Hernia Repair. Frontiers in Surgery. 2015; 2: 13.

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