Aetiology

The abdominal muscle tissue weakens for the following reasons:

• - Injury in the area as a result of a traumatic accident
• - Ageing, which results in changes to the diaphragm
• - Increase in pressure on nearby muscles due to strain (vomiting, forceful bowel movements, coughing, heavy weight lifting, etc.)

Pathology

A barium swallow is a type of X-ray test that is used to confirm the presence of a hiatus hernia. The test involves drinking a dense, chalk-like liquid (barium) so that the radiologist can see how the fluid moves down the throat, while at the same time, x-ray images are taken.

An endoscope is a fine, bendable instrument that is passed through the oesophagus and guided into the stomach. As a result, your doctor will be able to view and confirm the presence of the hernia.

Risk factors

An untreated hiatus hernia can lead to the following risks:

• - Complications from acid reflux
• - Oesophagitis (inflammation of the oesophageal lining due to the recurring flow of stomach acid)
• - Coughing due to the rise of stomach acid that irritates the larynx.
• - Stricture leads to the narrowing of the lower part of the oesophagus due to persistent inflammation in the area.
• - The possibility of oesophageal cancer increases when the cells lining the lower end of the oesophagus begin to alter.
• - Strangulation arises when the blood supply to the affected tissue gets cut off.

Symptoms

• - Chest pain
• - Bad breath
• - Burping
• - Trouble swallowing (dysphagia)

Treatment & Surgery

• Medical therapy: Proton-pump inhibitors (PPIs) are types of medications prescribed to minimise the amount of stomach acid produced.
• Indications for surgery: Hiatus hernia repair is strongly suggested when acid reflux and heartburn continue to recur even after prescription medication use. Likewise, your doctor will suggest surgery should chronic inflammation persist even after modifying your lifestyle and diet.
• Surgical options and description of procedures: Diaphragmatic hernia repair involves repositioning the displaced abdominal organs and sealing the opening in the diaphragm. The organs must be removed from the chest and repositioned in the abdomen.   

Surgical techniques for a hiatus hernia include:

• Open surgery: An open procedure is considered invasive because your surgeon will create an extended cut over the abdomen. The stomach is placed in position and wrapped around the end of the oesophagus to tighten the sphincter.
• Laparoscopic surgery: Laparoscopic surgery is considered the less invasive approach when repairing a hiatus hernia. Surgical instruments are guided through these incisions using a laparoscope that consists of a miniature light and camera. Then, similar to open repair, your stomach is positioned safely inside the abdominal cavity. Afterwards, the top portion of the stomach is wrapped around the lower end of the oesophagus. Finally, using the stomach fundus, your surgeon can strengthen the sphincter, preventing acid reflux symptoms.