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Treatment for hiatal hernias

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Tony Anagnostou, MD

Have you ever been told you have a hiatal hernia or a paraesophageal hernia? These hernias are relatively common and are often diagnosed during an endoscopy, or incidentally on an X-ray or CT scan performed for other reasons.

Many patients are told that they should just “live with it” or that “nothing can be done,” but advances in minimally invasive surgery have changed the way surgeons around the country manage this condition. A hiatal hernia — or a paraesophageal hernia, which is basically a really big hiatal hernia — is a condition where the stomach has started to rise up into the chest when the hole the esophagus passes through gets stretched out.

It is frequently diagnosed and often gets worse over time. It typically causes heartburn/reflux symptoms, and some people will also have pain, difficulty swallowing, nausea or vomiting, and rarely life-threatening sudden problems. Current surgical recommendations are to repair all paraesophageal hernias in patients who are surgical candidates, because they tend to get progressively worse and can result in surgical emergencies.

This is different than 20 years ago, when the surgery was a very painful and difficult procedure. Now it can be done laparoscopically with “keyhole” incisions, typically with less than 24 hours in the hospital. The decreased risk and post-surgical discomfort means it makes sense to fix the problem before it gets worse over time.

Hiatal hernias, or smaller hernias, are also often candidates for surgery, but if the hiatal hernia is very small, it is typically only recommended for surgery if there is life-altering/refractory acid reflux, trouble swallowing, or other difficult complications. If you have severe acid reflux problems that are not being well controlled with medications, or have a large hiatal hernia or paraesophageal hernia, feel free to drop our office a line to set up an appointment to discuss your specific case.

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Tony Anagnostou is a medical doctor for Eastern New Mexico Medical Group. The advice offered in this column is that of the author.