Hiatal hernia is an anatomic disorder in which portions of the stomach go through the opening in the diaphragm into the chest. This can cause not only symptoms associated with GERD such as heartburn and pain, but also symptoms of having the stomach up in the chest such as getting full after eating small amounts of food or becoming short of breath. Patients often turn to surgery as an option when the symptoms from the hiatal hernia impact their daily life.
The diagnosis is typically made initially with EGD. There are different degrees of hiatal hernia ranging from a small amount of the stomach to all of the stomach in the chest. The goal of surgery is to bring the stomach back down into the abdomen and place a barrier between the esophagus and the stomach.
In order to provide the best surgical outcome, we obtain the following studies to determine the patient’s anatomy, the esophageal function and the relationship between the patient’s symptoms and the amount of acid coming up to the esophagus:
- Esophagram—This study is performed by a radiologist. The patient drinks barium under an X-ray, which highlights the anatomy of the esophagus and stomach.
- Manometry—This study is performed in a GI lab. A small probe is placed in the esophagus through the nose. The patient swallows with the probe placed in the esophagus that provides information about esophageal function
- 24 hour pH impedance—This study is performed in a GI lab. A small probe is placed in the nose. The patient wears the probe for 24 hours. During that time, the patient keeps a journal of all of the symptoms. The record of the symptoms and the amount of acid that comes up to the esophagus during the study provides the degree of esophageal reflux.
These studies allow us to advise patients about the best surgical option and the degree of success with surgical treatment of hiatal hernia. All of the options include hiatal hernia repair but there are three different ways to create a barrier:
- Nissen fundoplication
- Toupet fundoplication