Hiatal Hernia

The oesophagus enters the abdomen via the diaphragmatic hiatus, which is susceptible to ventral hernia since it is subject to stress between the chest and abdomen. Hiatus hernia, a condition that involves herniation of your abdominal contents, runs through the diaphragmatic hiatus and then into the thoracic mediastinum, says Dr. Purnendu Bhowmik, who is considered to be the best hernia surgeon in Kolkata.

Types

According to the best doctor for hiatal hernia in Kolkata, the different types of hiatal hernia are:

• Type I: These hernias, also called the sliding hernia, are the most common (95%). The gastroesophageal junction moves above the diaphragm in people with sliding hernia. The stomach sits in its original position while the fundus is just below the gastroesophageal junction.
• Type II: These are para-esophageal hernias (PEH), where the gastroesophageal junction remains in its usual position. However, a part of the fundus protrudes the diaphragmatic hiatus.
• Type III: The type III hernias are a combination of the first and second types, with both the fundus and gastroesophageal junction sticking out through the hiatus.
• Type IV: These hernias involve the presence of a structure other than the stomach, including the colon, small bowel, and omentum.

Symptoms

Small hernias — Most of the small hiatal hernias do not cause any problems.

Large hernias — The larger hernias sometimes cause the following signs and symptoms.

• Belching
• Heartburn
• Nausea
• Chest pain

The abovementioned signs and symptoms may get worse when you lift heavy objects, lean forward, strain, and lie down, as well as during pregnancy. Rarely, the portion of the stomach that herniates into the chest cavity may get strangulated or have the blood supply cut off, causing:

• Severe chest pain
• Obstruction of your esophagus
• Difficulty in swallowing (dysphagia)

Risk Factors

• Obesity
• Smoking
• Age 50 or older
• Congenital defects : The most common of paraesophageal hernia in kids

Diagnosis

• Endoscopy: Clinical indications for endoscopy include

• GERD symptoms that are unmanageable by treatment
• Alarming signs such as bleeding, weight loss, dysphagia, anaemia or
• Symptoms in people who are above 50

• Radiologic imaging: Hiatal hernia can be accurately detected, but with poor sensitivity for complications of mucosa. Radiology is usually preferred for the presurgical evaluation.
• pH testing: Itis important for identifying the presence of increased oesophageal acid exposure in people with sliding hernias that might benefit from antireflux surgery.
• High-resolution manometry with reflux monitoring: Functional oesophageal testing with manometry and reflux monitoring is needed when surgical treatment is considered to control the symptoms of GERD associated with hiatal hernia.

Complications

• Bleeding and anemia
• Reduced blood flow to stomach
• GERD
• Difficulty swallowing
• Barrett’s esophagus
• Esophageal Cancer

Treatment options

• Lifestyle modifications

• Limit fatty foods
• Stop smoking
• Eat small meals
• Avoid problem foods and alcohol
• Don’t exercise immediately after eating
• Elevate the head of your bed
• Sit up after you eat
• Lose Weight
• Avoid tight-fitting clothes

• Medical: Lessening of GERD symptoms is primarily important for treating hiatus hernia and is usually achieved with Proton pump inhibitors (PPIs). Some alternatives to PPIs are histamine 2 receptor antagonists and antacids.
• Surgical: Some patients with hiatal hernia may require surgery. It is considered only when lifestyle and medicinal changes fail to relieve the symptoms, or complications like chronic bleeding or narrowing of the oesophagus occur.

Large hiatal hernias also sometimes need repair or laparoscopic surgery in Kolkata if symptoms like difficulty breathing or swallowing, shortness of breath, or chest pain are experienced.

Laparoscopic fundoplication: Currently, the fundoplication is the standard procedure performed by the best laparoscopic surgeon in Kolkata. This technique involves mobilization of the distal oesophagus, lessening the associated hiatus hernia, followed by either partial or complete fundoplication around the oesophagus.