Hiatal Hernia Treatment in Delhi, India

Overview

A hiatal hernia happens when the upper part of the stomach bulges through the hiatus, a small opening in the diaphragm that separates the chest from the abdomen. Normally, the esophagus passes through this opening to connect to the stomach, but in this condition, part of the stomach moves into the chest cavity. While small hiatal hernias may not cause any noticeable symptoms, larger ones can result in discomfort, such as heartburn and acid reflux.

Types of Hiatal Hernia

Hiatal hernias are primarily divided into two categories:

• Sliding Hiatal Hernia:
  This is the most prevalent type, where the stomach & lower esophagus move upward into the chest through the diaphragm.
• Paraesophageal (Fixed) Hiatal Hernia:
  Less common but potentially more serious, a paraesophageal hernia occurs when a part of the stomach protrudes through the diaphragm and becomes trapped in the chest cavity. In uncommon instances, it may restrict blood flow to the stomach, leading to a medical emergency.

Symptoms of Hiatal Hernia

While many hiatal hernias cause no symptoms, larger ones may present signs such as:

• Heartburn
• Acid reflux
• Chest discomfort
• Abdominal pain
• Difficulty swallowing
• Shortness of breath
• Vomiting
• Black or tarry stools
• Bloating
• Regurgitation of food or liquids

Seek immediate medical attention if you experience:

• Severe chest or abdominal pain
• Inability to pass gas or stool
• Persistent nausea or vomiting

Causes of Hiatal Hernia

Several factors that can contribute to its development include:

• Persistent pressure on the abdominal muscles due to activities such as coughing, vomiting, heavy lifting, or straining during bowel movements.
• Injury or trauma to the diaphragm
• Congenital factors, such as being born with a larger-than-normal hiatus, can also contribute.
• Muscle weakening due to aging

Diagnosing Hiatal Hernia

Several diagnostic tests help confirm the presence of a hiatal hernia:

• Barium Swallow Test:
  Following the ingestion of a barium solution, X-rays are performed to capture images of the esophagus, stomach & hernia.
• Upper Endoscopy: A thin, flexible tube equipped with a camera is inserted through the throat to inspect the esophagus and stomach.
• Esophageal Manometry: This test evaluates the muscular movements of the esophagus to assess its proper functioning.
• pH Monitoring: This test monitors acid levels in the esophagus continuously over a 24-hour period.”
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• CT Scan:
  Used to identify complications such as gastric volvulus or perforation.

Hiatal Hernia Treatment Options

For many individuals, hiatal hernias are manageable without invasive treatment. However, larger or symptomatic hernias often need medical treatment.

1. Medications

While medications cannot cure a hiatal hernia, they can alleviate symptoms:

• Antacids: Neutralize stomach acid.
• H2 Receptor Blockers: Decrease acid production.
• Proton Pump Inhibitors (PPIs): Promote healing of the esophagus & reduce acid production.

2. Lifestyle Modifications

Doctors often recommend certain lifestyle changes to minimize symptoms:

• Eat smaller, more frequent meals
• Avoid lying down immediately after eating
• Elevate the head of the bed
• Lose weight if overweight
• Avoid foods and beverages that trigger reflux (like spicy foods, caffeine, and alcohol)

3. Surgical Treatments

When lifestyle changes and medications are not enough — especially in cases involving paraesophageal hernias or complications — surgery is advised:

• ·  Laparoscopic Hiatal Hernia Repair: This minimally invasive technique involves creating small abdominal incisions to repair the hernia.
• ·  Laparoscopic Nissen Fundoplication: In this procedure, the upper part of the stomach (fundus) is wrapped around the lower esophagus to reinforce the hiatus and minimize acid reflux. This method enhances the barrier against stomach acid, improving overall function.
• Robotic-Assisted Surgery (Next-Gen Technology):
  At select advanced centers in Delhi, the latest robotic systems like the VERSIUS robot from CMR Surgical, UK are used. These systems offer:
  • 3D, high-definition vision for greater surgical precision
  • Improved surgeon control through flexible robotic arms
  • Shorter surgery times
  • Faster recovery with fewer complications
  • Open console design for better patient monitoring during the operation

Risk Factors for Hiatal Hernia

Certain factors can increase the likelihood of developing a hiatal hernia:

• Obesity
• Smoking
• Aging (especially after 50 years)
• Genetic predisposition

Preventing Hiatal Hernia Symptoms

• While most hiatal hernias are harmless, they can occasionally lead to complications such as:
• Maintain a healthy weight
• Avoid heavy lifting
• Eat smaller portions and chew food thoroughly
• Limit intake of caffeine, alcohol, and acidic foods
• Wear loose-fitting clothes
• Quit smoking
• Avoid straining during bowel movements

Potential Complications

• Gastroesophageal Reflux Disease (GERD)
• Respiratory issues
• Strangulation of the stomach, which can interrupt blood flow and become a surgical emergency.

Prognosis After Hiatal Hernia Treatment

With proper care, the outlook for individuals with hiatal hernias is generally excellent. Minor hernias can be managed through diet and lifestyle adjustments. Larger hernias requiring surgery typically have very positive outcomes, especially when treated with modern laparoscopic or robotic-assisted techniques. In cases where GERD persists along with a hernia, surgical correction provides long-term relief and improves quality of life.