Asymptomatic axial hiatus hernias, which may be a random finding, do not necessarily have to be treated. For mild symptoms such as heartburn, a change in sleeping position may be helpful at first. A raised upper body reduces the backflow of gastric acid into the oesophagus.
In the case of reflux esophagitis, i.e. inflammation of the esophagus due to continuous acid reflux, acid production can be inhibited by medication. So-called proton pump inhibitors, such as pantoprazole, inhibit the production of hydrochloric acid in the stomach and less acid can flow up the oesophagus. In the case of severe symptoms, such as a restriction of the lungs and heart or a circulatory disorder of the stomach, surgery is necessary.
The displaced parts of the organ are put back through the fracture and the upper part of the stomach is sutured to the diaphragm. In this way a relapse can be prevented. In the case of very large defects in the diaphragm, a plastic net can also be sewn in to prevent the abdominal organs from sliding up. In acute operations, especially in paraesophageal hernia, intensive medical care is necessary after the operation and newborns must be ventilated.
Also very fatty foods increase the acid production in the stomach. Well-known triggers of heartburn include fruit juices, alcohol, coffee and all fatty foods. Directly before going to bed, affected persons should not eat any more, as the change of position of the body also promotes reflux. The hernia itself is no reason for a special diet. You can find more detailed information and nutritional tips in our article on the topic of nutrition for heartburn
When is an operation necessary?
The necessity of surgery on an axial hiatus hernia depends on the severity of the symptoms. If the symptoms, such as heartburn, cannot be treated conservatively, surgery may be considered. In case of complications, i.e. a constriction of the heart and lungs or a circulatory disorder of the stomach, surgery is necessary. Paraesophageal hernia is always an indication for surgery, as breathing is restricted and parts of the stomach can die.
Procedure of the operation
There are different options for the operation depending on the type of hernia. The operations are always performed under general anaesthesia. With the exception of emergency operations, there is a consultation with the responsible anaesthetist before the operation, so that the anaesthesia can be planned individually.
If only the reflux of gastric acid is to be prevented, a narrowing of the esophagus may be sufficient. In a normal axial hiatal hernia, the stomach is first returned through the diaphragmatic opening. Here the surgeon pays attention to possibly undersupplied and dead parts of the stomach, as these would have to be removed to prevent blood poisoning.
The diaphragmatic opening is narrowed and stabilized with a ring to prevent the formation of a new hernia. In addition, the upper side of the stomach is sutured to the diaphragm, thus stabilizing the position in the upper abdomen. In the case of larger defects of the diaphragm, such as especially in congenital paraesophageal hernia, a plastic mesh can be sewn in to prevent the abdominal organs from shifting. These operations require intensive medical care afterwards, whereas in the case of a normal axial hernia a normal ward is sufficient for follow-up treatment.