A hiatal hernia is a condition in which the upper stomach bulges through a gap in a weakened diaphragm. It is also the term given to other organs that experience the same phenomenon. This change can cause considerable discomfort, and is one of the most common reasons for patients developing gastroesophageal reflux disease (GERD).
There are four classifications of hiatal hernia, and the condition can be congenital or acquired. In fact, most adults acquire the issue far later in life. Moreover, older patients are at a higher risk than younger adults because of increased muscle weakness and a loss of tissue flexibility. (1) Renowned Las Vegas bariatric surgeon Dr. Mustafa Ahmed performs standalone hiatus hernia surgeries, or in conjunction with a bariatric procedure such as a gastric sleeve or gastric bypass. To book your personal consultation with him, call Southern Nevada Bariatrics at (702) 626-0499 or complete a patient inquiry form for more details.
- 1 Do I Have a Hiatus Hernia?
- 2 A Silent Problem?
- 3 Candidates for Surgery
- 4 Personal Consultation
- 5 Lifestyle Habits
- 6 Diagnostic Testing
- 7 Repair Surgery
- 8 Cost of Hiatal Hernia Repair in Las Vegas, NV
- 9 FAQ
- 10 References
Do I Have a Hiatus Hernia?
Hiatal hernias are very common, especially in adults over the age of 50. They happen because an essential muscle that helps us breathe, the diaphragm, develops a weakness, and part of the stomach (the fundus) bulges through.
The diaphragm is a large, dome-shaped muscle responsible for our breath control. It divides the thorax and the abdomen, and the stomach sits directly below it. It is often referred to as the “umbrella muscle”, due to its shape.
When we breathe in, the diaphragm contracts and the chest cavity gets bigger. And when we breathe out, the diaphragm relaxes, and air is expelled from the lungs. A healthy diaphragm has a small hole (the diaphragmatic crus), through which the esophagus connects with the stomach at the esophageal sphincter. Unfortunately, the diaphragm is in constant use, and is under constant pressure when we breathe, making it vulnerable to weakness. When this occurs, the stomach protrudes through the gap, causing a hiatal hernia.
Classification of Hiatal Hernia
- Type I: The most common type of hiatal hernia is also known as a sliding hernia. The stomach bulges through the diaphragmatic crus symmetrically. This type of hernia is most associated with symptoms of GERD. Over 90% of all hiatal hernias are classified as Type I. (2)
- Type II: Also known as pure paraesophageal hernias (PEH). A portion of the top of the stomach directly alongside one side of the esophagus.
- Type III: A combination of Type I and Type II hernias.
- Type IV: Non-stomach organs herniate through the thoracic cavity. These include the small bowl, colon, or spleen.
The risk of developing a hiatus hernia is quite low in young adults, however, the risk increases with age, and so does the size of the hernia. Hiatal hernias over 2 cm (0.79 in) are associated with multiple worsened GERD symptoms and are associated with older age. (3)
A Silent Problem?
Awareness of hiatal hernia symptoms is essential for effective treatment. However, you may not feel any different. Between 50-60% of individuals over the age of 50 have the condition, but a mere 9% of patients show any symptoms. (3)
Signs of Hiatal Hernia
If you are experiencing symptoms, the major signs you may have a hiatal hernia are as follows. (2)
- Severe Heartburn
- Acid Reflux
Less common symptoms include the following.
- Chest Pain
- Abdominal Pain
- Difficulty Swallowing
- Iron Deficiency/Anemia
- Feeling Full Faster
In some cases of hiatal hernia, you may not have any obvious symptoms, but if you feel something is wrong, arrange an appointment with Dr. Ahmed at your earliest convenience.
Candidates for Surgery
Hiatal hernia repair may only be necessary The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) states that hiatal hernia repair is particularly important in the following circumstances. (4)
- Symptoms of discomfort with type II hernia
- Type I hernia if regurgitation persists despite treatment
The following less common, but serious, issues must be addressed surgically.
- Digestive obstruction
- Abnormal rotation of the stomach (gastric volvulus)
The SAGES Guidelines do not recommend surgery for asymptomatic type I hernias.
Sleeve Gastrectomy & Hiatal Hernia Repair
Where necessary, SAGES recommends bariatric surgery, such as sleeve gastrectomy (gastric sleeve surgery) if a patient with a hiatal hernia has weight concerns. The sleeve gastrectomy converts the stomach into a sleeve-like shape to help patients lose a significant amount of weight. Hiatal hernia repair and Sleeve gastrectomy can safely be performed at the same time. If you have a BMI over 40, or a BMI over 35 with an obesity-related condition, such as type 2 diabetes, speak to Dr. Ahmed about a combination surgery at Southern Nevada Bariatrics.
At your personal consultation, Dr. Ahmed will speak to you about your medical history, your diet, your current medications, and the symptoms you are experiencing. In particular, he will ask you about the frequency and intensity of your heartburn and reflux. He will then perform the necessary preliminary tests to discern the issues at hand and draw up a treatment plan for hiatal hernia repair. Call (702) 626-0499 to book your appointment with leading Las Vegas bariatric surgeon Dr. Mustafa Ahmed, find relief from GERD, and solve your hiatal hernia issues.
Dr. Ahmed may recommend lifestyle changes and prescription medication to see if GERD symptoms resolve without surgery. When appropriate, patients may be directed to do the following.
- Lose excess weight
- Take proton pump inhibitor (PPI) medication
- Elevate the head 8 inches during sleep
- avoid meals 2-3 hours before bedtime,
- Eliminate “trigger” foods
GERD-triggering foods and beverages include: chocolate, alcohol, caffeine, spicy foods, citrus, and carbonated drinks.
Find out more about medical weight loss at Southern Nevada Bariatrics.
Some patients may have gastroesophageal issues but not have a physical problem with the stomach and diaphragm. In fact, typical GERD symptoms can occur without a hiatal hernia. Dr. Ahmed may use a number of tests for a differential diagnosis.
The barium swallow is essential to hiatal hernia diagnosis. Barium is a chalky substance that appears brightly on X-ray film. The patient swallows a liquid containing the element barium, then the doctor takes X-rays. The barium helps the doctor to visualize the passage of the digestive tract. (2)
An EGD, sometimes called an upper endoscopy, is a short, real-time visualization of the digestive tract. The doctor passes a small, flexible endoscopic camera down the throat to examine the esophagus, the stomach, and the duodenum, the first part of the small intestine. (2)
Esophageal manometry measures coordinated muscle movement in the upper digestive tract. A catheter is placed through the nose and down into the stomach. The patient sips water while the doctor measures pressure in the lower esophageal sphincter, the valve that separates the stomach and the esophagus.
Dr. Ahmed may use a transabdominal approach (through the abdomen) or a transthoracic approach (through the thorax) to access the area of concern, depending on your treatment plan. There are various surgical techniques for hiatal hernia which can be performed using an open method, or a minimally-invasive laparoscopic technique. Laparoscopic antireflux surgery (LARS) is an alternative to open surgery as it has the following advantages. (5)
- Safe and effective treatment option
- Excellent midterm outcomes
- Excellent long-term functional outcomes
- High patient satisfaction
- significantly improves long-term quality of life
Dr. Ahmed understands that every patient’s needs are different. Therefore, every hiatal hernia repair will be based on the patient’s unique situation. For more information, and to begin medical treatment of GERD and hiatal hernia, please speak to us to arrange your personal consultation
Cost of Hiatal Hernia Repair in Las Vegas, NV
The cost of your hiatal hernia treatment will depend on the nature of your treatment plan. Southern Nevada Bariatrics offers cash pay and financing for qualified patients. Free yourself from the uncomfortable symptoms of GERD and arrange your hiatal hernia treatment plan with Dr. Ahmed by calling us directly at (702) 626-0499 or use our online form to get in touch.
Are there different types of hernia?
Yes. There are four types of hiatal hernia. Type 1 involves symmetrical bulging of the stomach from beneath the diaphragm. Type 2 involves the stomach herniation appearing to the side of the esophagus. Type 3 is a combination of types 1 and 2. And type 4 occurs when another organ (such as the past of the small intestine) herniates through the wall of the diaphragm.
How do I know if I have a hiatal hernia?
Sometimes people don’t! In the majority of cases, a hiatal hernia will present with no symptoms. However, if you have severe heartburn, regurgitation, and acid reflux, speak to your doctor and arrange testing to determine the presence of a hiatal hernia.
How long does hiatal hernia repair surgery take?
There are several approaches to hiatal hernia surgery. On average the surgery will last between 2-3 hours.
- Smith RE, Shahjehan RD. Hiatal Hernia. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK562200/
- Sfara A, Dumitrascu DL. The management of hiatal hernia: an update on diagnosis and treatment. Medicine and Pharmacy Reports. 2019;92(4):321-325. doi:10.15386/mpr-1323
- Shahsavari D, Smith MS, Malik Z, Parkman HP. Hiatal hernias associated with acid reflux: size larger than 2 cm matters. Diseases of the Esophagus. Published online January 22, 2022. doi:10.1093/dote/doac001
- Guidelines for the Management of Hiatal Hernia – A SAGES Publication. SAGES. Published 2013. https://www.sages.org/publications/guidelines/guidelines-for-the-management-of-hiatal-hernia/
- Granderath FA. Laparoscopic Nissen Fundoplication With Prosthetic Hiatal Closure Reduces Postoperative Intrathoracic Wrap Herniation. Archives of Surgery. 2005;140(1):40. doi:10.1001/archsurg.140.1.40