Hiatus Hernia

A hiatus hernia is a medical condition in which part of the stomach protrudes upward into the chest through an opening in the diaphragm called the hiatus. The diaphragm is a muscle that separates the chest cavity from the abdominal cavity.

There are two main types of hiatus hernias:

Sliding hiatus hernia: This is the most common type of hiatus hernia. In a sliding hiatus hernia, a portion of the stomach and the junction between the esophagus and the stomach (gastroesophageal junction) slide upward into the chest through the hiatus. This can lead to symptoms such as heartburn, regurgitation, chest pain, and difficulty swallowing.

Paraesophageal hiatus hernia: In this type, a portion of the stomach pushes through the hiatus next to the esophagus but doesn't slide upward into the chest. Instead, it remains in the chest alongside the esophagus. This type of hernia is less common but more serious, as it can lead to complications such as strangulation and bleeding.

Hiatus hernias can be caused by a variety of factors, including:

Weakness in the diaphragm: The diaphragm is a muscle that separates the chest cavity from the abdominal cavity. A weakness in the diaphragm can allow part of the stomach to protrude into the chest through the hiatus, an opening in the diaphragm.

Age: Hiatus hernias are more common in older adults, as the diaphragm muscle can weaken with age.

Obesity: Excess weight can put pressure on the stomach and lower esophageal sphincter (LES), which can lead to a hiatus hernia.

Genetics: Hiatus hernias may run in families, suggesting there is a genetic component to the condition.

Pregnancy: Pregnancy can increase abdominal pressure, which can lead to a hiatus hernia. In most cases, the hernia resolves after childbirth.

Smoking: Smoking can weaken the LES, which can increase the risk of acid reflux and, over time, a hiatus hernia.

Heavy lifting: Frequent heavy lifting can increase abdominal pressure and potentially contribute to the formation of a hernia.

Chronic coughing or straining: Conditions that lead to chronic coughing or straining, such as COPD or constipation, can put additional stress on the diaphragm and contribute to the formation of a hernia.

Hiatus hernias can cause a variety of symptoms, including:

Heartburn: A burning sensation in the chest, often after eating.

Regurgitation: The sensation of stomach acid or food coming back up into the throat or mouth.

Chest pain: A sharp or squeezing pain in the chest that may radiate to the neck, jaw, or back.

Difficulty swallowing: A sensation of difficulty or discomfort when swallowing.

Belching or burping: Excessive belching or burping.

Shortness of breath: In some cases, shortness of breath, especially during physical activity.

Other less common symptoms of hiatus hernias may include:

Nausea and vomiting


Bad breath




Barium swallow X-ray: This is the most common imaging test used to diagnose hiatus hernias. You will drink a liquid that contains barium, which coats your digestive system and makes it easier to see on X-rays.

Upper endoscopy: A thin, flexible tube with a camera on the end (endoscope) is inserted through your mouth and into your esophagus and stomach. This allows your doctor to see the inside of your digestive system directly.

Esophageal pH monitoring: This test measures the amount of acid in your esophagus over a period of time. It can help diagnose GERD, which is often associated with hiatus hernias.

CT scan: A CT scan uses X-rays to create detailed images of the inside of your body. It can be used to assess the anatomy of the diaphragm and herniated structures, especially if there are complications or if other diagnostic methods are inconclusive.

Manometry: This test measures the muscle function of the esophagus and the lower esophageal sphincter (LES). It can help assess the pressure and coordination of muscle contractions in the esophagus and LES.

Lifestyle Modifications

Dietary changes: Avoid foods that trigger acid reflux, such as spicy, fatty, and acidic foods. Eat smaller, more frequent meals.

Weight management: Losing excess weight, especially if you are overweight or obese, can help alleviate symptoms by reducing abdominal pressure.

Posture and positioning: Avoid lying down or bending over immediately after meals. Elevate the head of your bed or use a wedge pillow to prevent acid reflux during sleep.

Smoking cessation: Quitting smoking can improve LES function and reduce the risk of acid reflux.

Avoiding tight clothing: Wearing tight belts or clothing that compresses the abdomen can increase pressure on the stomach and contribute to reflux.

Medical Treatment

Antacids: Over-the-counter antacids can provide temporary relief from heartburn and acid reflux symptoms.

Proton pump inhibitors (PPIs): Prescription or over-the-counter PPIs can reduce stomach acid production and help heal the esophagus if it’s been damaged by acid reflux.

H2 blockers: H2 blockers are medications that reduce acid production in the stomach and can provide relief from heartburn.

Laparoscopic Surgery for Hiatus Hernia

If lifestyle changes and medications do not effectively control symptoms, or if there are complications (e.g., severe bleeding, strangulation of the hernia), surgery may be recommended. Laparoscopic surgery is a minimally invasive procedure that is often used to repair hiatus hernias. It is a safe and effective way to relieve symptoms and improve quality of life.

During laparoscopic surgery, a surgeon makes several small incisions in the abdomen and inserts a thin, telescope-like camera and surgical instruments through the incisions. The camera allows the surgeon to see the inside of the abdomen without having to make a large incision.

The surgeon then repairs the hiatus hernia and reinforces the lower esophageal sphincter to prevent further herniation. In some cases, the surgeon may also perform a fundoplication, which is a procedure that involves wrapping the top of the stomach around the lower esophagus to strengthen the LES and prevent reflux.

Laparoscopic Nissen Fundoplication

Laparoscopic Nissen fundoplication is a type of fundoplication that is commonly used to treat hiatus hernia and GERD. In this procedure, the surgeon wraps the top of the stomach around the lower esophagus in a complete 360-degree rotation. This helps to strengthen the LES and prevent acid from flowing back into the esophagus.

Laparoscopic Nissen fundoplication is a safe and effective procedure, but it is important to note that it is a major surgery. There are some potential risks and complications associated with the surgery, such as bleeding, infection, and difficulty swallowing.

If you are considering surgery for a hiatus hernia, talk to your doctor about the benefits and risks of laparoscopic Nissen fundoplication.

Additional Safety Guidelines

Do not self-diagnose or self-treat a hiatus hernia. See a doctor for diagnosis and treatment.

Be careful when taking over-the-counter medications for heartburn and acid reflux. Some of these medications can have side effects, especially if taken long-term.

If you are considering surgery for a hiatus hernia, talk to your doctor about all of your options and the risks and benefits of each option.

Follow your doctor’s instructions carefully after surgery. This will help to ensure a safe and successful recovery

In short, a hiatus hernia is when part of the stomach pushes up through the diaphragm into the chest, potentially causing symptoms like heartburn and regurgitation. Diagnosis involves medical history, physical exams, and imaging tests. Treatment options include lifestyle changes, medications, and surgery, depending on the severity. Surgery aims to repair the hernia and prevent reflux, and it can be done using open, laparoscopic, or robotic-assisted methods. Regular follow-up care is crucial for managing the condition and its symptoms.

We are a specialized center for laparoscopic hiatus hernia repair in Nepal. If you have a hiatus hernia, please do not hesitate to contact us for expert care and treatment.

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