Hiatal Hernia Support Group

Where severe and chronic acid reflux is involved, surgery, is sometimes recommended, as chronic reflux can severely injure the esophagus. Persons requiring surgery might experience heartburn or might not perceive any symptoms.

There are two kinds of Hiatal Hernia: The first (95%) is the sliding hiatal hernia, where the gastroesophageal junction moves above the diaphram together with some of the stomach. The second kind is when a part of the stomach herniates through the hiatus beside, and without movement of, the gastroesophageal junction.

A Nissen fundoplication is performed laparoscopically; however, this can have both severe and minor side-effects. Minor side-effects of this procedure include increased production of stomach and intestinal gas, and chronic nausea; major ones include permanent severe discomfort when eating and passing food into the stomach, inability to vomit or belch normally, and limited stomach capacity.

Symptoms depend greatly on individual anatomy and surgical technique, but due to the severe degree of potential discomfort in some cases, surgery is only recommended as a last resort if medication therapy is ineffective or impractical. Traditionally, surgery was recommended as a primary solution, but a statistical increase in complications and severe discomfort levels among patients, resulting from the high volume of procedures performed, has led to a radical change of practice and attitiude.

Symptomatic patients should be told to elevate the head of their beds and avoid lying down directly after meals. If overweight, weight loss is indicated. Medications that lower the LES pressure should be avoided. Antisecretory drugs like proton pump inhibitors and H2-receptor blockers can be used to reduce acid secretion. Endoscopic plication or radiofrequency energy delivery to the LES may be considered. Surgery should be considered if these modalities don't work. Surgery usually consists of Nissen fundoplication, which usually is successful in eradicating symptoms.