Introduction

Hiatus hernia is a condition that affects the upper part of your stomach and diaphragm. It occurs when the upper part of the stomach bulges through an opening in the diaphragm called the hiatus. This can lead to symptoms like heartburn, regurgitation, chest pain, and difficulty swallowing. While lifestyle changes and medications can often help manage symptoms, some cases may require surgical intervention known as antireflux surgery.

Understanding Hiatus Hernia

The diaphragm is a large muscle that separates the chest cavity from the abdominal cavity and helps in breathing. The esophagus passes through an opening in the diaphragm called the hiatus before connecting to the stomach. When the muscles and tissues around the hiatus weaken, the upper part of the stomach can protrude into the chest cavity, causing a hiatus hernia.

Types of Hiatus Hernia

• Sliding Hiatus Hernia: The most common type, where the gastroesophageal junction (the area where the esophagus meets the stomach) and part of the stomach slide into the chest.
• Paraesophageal Hiatus Hernia: A less common type, where a portion of the stomach squeezes through the hiatus next to the esophagus. This can lead to complications like strangulation or obstruction of the stomach.

Symptoms of Hiatus Hernia

• Heartburn: A burning sensation in the chest due to stomach acid refluxing into the esophagus.
• Regurgitation: The backflow of stomach contents into the mouth.
• Chest Pain: Discomfort or pain in the chest, which may be confused with heart-related issues.
• Difficulty Swallowing: A sensation of food sticking in the throat or chest.
• Belching: Excessive burping, often accompanied by bloating.

Diagnosis and Treatment

Doctors may diagnose hiatus hernia through a combination of medical history, physical examination, and diagnostic tests such as:

• Endoscopy: A flexible tube with a camera used to examine the esophagus and stomach.
• Barium Swallow: A test where a contrast solution is swallowed to visualize the esophagus and stomach.
• pH Monitoring: Measuring the level of acidity in the esophagus to assess reflux.

Treatment often begins with lifestyle modifications, including avoiding large meals, fatty foods, and caffeine. Medications to reduce acid production and alleviate symptoms are commonly prescribed.

Antireflux Surgery

Antireflux surgery, also known as fundoplication, is considered when conservative treatments fail to provide relief or when complications arise from hiatus hernia. The goal of antireflux surgery is to reinforce the lower esophageal sphincter (LES) to prevent stomach contents from refluxing into the esophagus.

How Antireflux Surgery Works

During fundoplication, the surgeon wraps the upper portion of the stomach (fundus) around the lower esophagus to strengthen the LES and prevent acid reflux. This procedure can be performed through traditional open surgery or minimally invasive techniques like laparoscopy.

Advantages of Antireflux Surgery

• Effective: Provides long-term relief from symptoms in many patients.
• Minimal Scarring: Minimally invasive procedures result in smaller incisions and less visible scarring.
• Reduced Recovery Time: Quicker recovery compared to traditional open surgery.

Risks and Considerations

While antireflux surgery is generally safe and effective, it’s essential to consider potential risks, including:

• Infection at the surgical site
• Bleeding during or after surgery
• Difficulty swallowing
• Gas bloating and discomfort
• Recurrence of symptoms