Hiatal hernia operation expert Dag
Your Specialized Center for Hernia Treatment

Hiatal hernia
(Hiatus hernia)

What is a hiatal hernia? How can you recognize the so-called hiatus hernia? What is the procedure for hiatal hernia surgery? We will be happy to advise you in our practices in Hamburg. An initial overview of common questions about hiatal hernia follows here.

Good to know: A hiatal hernia does not necessarily require surgery. However, hiatal hernia surgery is recommended if you suffer from severe discomfort. We also advise surgery if there is a risk of damage to the esophagus as a result of the hiatal hernia.

Hiatal hernia surgery: 3 reasons for our hernia center in Hamburg

  • In expert hands from A to Z: At our locations in Hamburg, you will only meet hernia specialists with your hiatal hernia.
  • Our experience – your safety: Our doctors look back on 30,000 hernia operations between them – a wealth of experience that is unique in the world.
  • Preliminary examinations – diaphragmatic hernia surgery – follow up: In our practices and clinics in Hamburg, we are at your side throughout the entire healing process.

Beforehand in a nutshell

How does a hiatal hernia occur?
A hiatal hernia is the widening of a natural gap in the diaphragm through which the esophagus passes from the chest cavity into the abdominal cavity – caused by a weakness of the connective tissue and favored by a strong, persistent increase in pressure in the abdominal cavity.

Can a hiatal hernia become dangerous?
Due to the continuous acid reflux, the inflammation and cancerous change of the esophageal mucosa is possible. In addition, a hiatal hernia can lead to incarceration and displacement of the stomach in particular into the hernial space. Possible consequences: displacement of the heart and lungs, as well as bleeding from the stomach – in the worst cases, acute emergencies.

Which surgery method for a hiatal hernia?
When medication alone is not successful, minimally invasive surgery can be used to move the stomach into proper position and precisely reduce the gap in the diaphragm. By forming a cuff around the lower portion of the esophagus, a new valve mechanism is created that can safely prevent acid from refluxing into the esophagus.

Hiatal hernia - what is it?

Hiatal hernia, or hiatus hernia, is an “internal abdominal wall hernia”. Thus, the hiatal hernia occupies a special position among the various types of hernias.

Hiatal hernia refers to a defect in the diaphragm (boundary between chest and abdomen). There is a natural opening where the esophagus and accompanying nerves enter the abdomen. This is normally only large enough for the esophagus to fit through. An extension of this natural opening is a hiatal hernia. As a result, organs from the abdominal cavity can slide through the widened gap into the chest cavity. As with all other hernias, the peritoneum protrudes into the slowly widening gap, forming an “internal hernial sac”.

Axial hiatal hernias are particularly common

A hiatal hernia can come in a variety of forms. Axial hernia is particularly common. In this case, the stomach entrance shifts upward through the hiatal hernia.

Another form is the paraesophageal hiatal hernia. In this case, the cardia (entrance into the stomach) remains below the diaphragm, and other parts of the stomach migrate into the chest cavity. While axial hiatal hernias can often be treated with medication, paraesophageal hiatal hernias call for surgery.

Axial and paraesophageal hiatal hernias may also occur as a mixed form.

Hiatal hernia: valve function between esophagus and stomach disturbed

The esophagus, normally held in its natural position by the diaphragm, distorts upward due to the wide gap. As a result, the healthy closure mechanism between the esophagus and stomach is impaired. In healthy people, the mechanism works like a valve: the inflow of liquid and solid food components into the stomach is enabled, but reflux is prevented. In the case of a hiatal hernia, this valve function is disturbed and stomach acid can flow back into the esophagus unhindered.

A typical consequence of a hiatal hernia: heartburn, which occurs especially at night and in a lying position.

Hiatal hernia operation expert Reinpold
Hiatal hernia: If medication does not help in the long term, we provide information about options for surgery in our partner clinics.

Hiatal hernia: Causes

The diaphragmatric gap is a natural weakness of the internal boundary of the abdominal cavity from the chest cavity. The main cause for the development of a hiatal hernia, i.e. a pathological hernia gap, is a congenital connective tissue weakness.

A hiatal hernia is also favored by strong permanent pressure increases in the abdominal cavity, e.g. with chronic coughing, frequent pressing or heavy physical work.

Symptoms and consequences

Common hiatal hernia symptoms include heartburn of varying severity, rising of fluid from the stomach, and “spillage” of fluids from the stomach and esophagus into the trachea. As a result, a hiatal hernia also leads to throat clearing, coughing as well as hoarseness, breathing problems, shortness of breath and even asthma.

The esophagus is particularly at risk due to a hiatal hernia: the persistent pathological wetting of the esophageal mucosa with aggressive gastric acid leads to various severe forms of inflammation up to cauterization and can also trigger poorly curable esophageal cancer.

The acid and fluid reflux (Latin: reflux) is particularly noticeable at night in a lying position. Many hiatal hernia patients report that they sleep with their upper body elevated – sometimes almost sitting up – because of the symptoms.

Diagnostics

Consultation

The first step in diagnostics is always a personal interview. In our practices in Hamburg you will only meet hiatal hernia experts. Together, we will shed light on your medical history, duration, type and severity of symptoms, and any pre-existing conditions.

Special examination for hiatal hernias

In cases of hiatal hernia with severe heartburn, the question arises whether surgery is indicated. To assess this, gastroscopy and special endoscopic examinations with manometry (pressure measurement) and pH-metry (acid measurement) are performed.

General examinations

In close cooperation and coordination with your family doctor, the necessary, general preliminary examinations such as ECG and laboratory tests (blood sampling) are performed.

Hiatal hernia operation expert Reinpold Niebuhr Berger Dag
Hiatal hernia experts: We operate on the hiatal hernia with small incisions. In some cases, a synthetic mesh is inserted.

Hiatal hernia treatment: surgery and alternatives

Hiatal hernia symptoms relieve with medication

Hiatal hernia surgery is by no means always necessary. Heartburn as a typical symptom of a hiatal hernia can initially be treated with acid-inhibiting tablets. These can significantly limit or even prevent the formation of gastric acid in the stomach wall cells. A complete healing of the inflammatory symptoms of the esophagus is possible, heartburn can be alleviated or stopped. In this case, drug treatment may be sufficient on a transitional or permanent basis, and hiatal hernia surgery may be bypassed.

However, if a disproportionately high sustained dosage of tablets is required, hiatal hernia surgery may be advisable. In this procedure, the causative pathological gap in the diaphragm is narrowed and an artificial valve mechanism is created.

Hiatal hernia surgery minimally invasive

If the necessary preliminary examinations (endoscopic pressure and acid measurement) speak in favor of a surgery, we perform it minimally invasively in our partner clinics in Hamburg.

By means of laparoscopy (“tube” or “keyhole” method; Greek: “laparoscopy”), the gap in the diaphragm is safely and precisely reduced and a new valve mechanism is created. This is done by forming a customized cuff that is placed around the lower part of the esophagus. In some cases – especially with large hiatal hernias – reinforcement of the diaphragm with a special synthetic mesh may be necessary.

Only small incisions in the abdominal wall are required for hiatal hernia surgery. We usually perform laparoscopic hiatal hernia operations in Hamburg as short in-patient procedures. You should therefore expect an in-patient stay of about 4-5 days in one of our partner clinics.

Hiatal hernia surgery - and then?

Minimally invasive hiatal hernia surgery is gentle on the patient. Mobilization for everyday activities (dressing, undressing, personal hygiene, walking, going for a walk) is immediate. At the latest after the wound has healed (approx. 10 – 14 days), it is possible to resume normal physical activities such as housework, light gardening, cycling and driving.

After hiatal hernia surgery, natural swelling of the lower esophagus often occurs at first. Temporary swallowing difficulties are possible after the operation. During the first 5 weeks after hiatal hernia surgery, we recommend changing the diet to 5 small meals a day.

Treatment of acid reflux into the esophagus with medication is usually no longer necessary after hiatal hernia surgery.