What's the treatment for hiatus hernia?
Once an abdominal hernia occurs it tends to increase in size. Some patients with abdominal hernias wait and watch for a while prior to choosing surgery. In these cases, they must avoid strenuous physical activity such as heavy lifting or straining with constipation. They may also wear a truss, which is a support worn like a belt to keep a small hernia from protruding.
People can tell if their hernia is getting worse if they develop severe constant pain, nausea and vomiting, or if the bulge does not return to normal when lying down or when they try to gently push it back in place. In these cases they should consult with their doctor immediately. But, ultimately, surgery is the treatment in almost all cases.
There are risks to not repairing a hernia surgically. Left untreated, a hernia may become incarcerated, which means it can no longer be reduced or pushed back into place. With an incarcerated hernia the intestines become trapped outside the abdomen. This could lead to a blockage in the intestine. If it is severe enough it may cut off the blood supply to the intestine and part of the intestine might actually die.
When the blood supply is cut off, the hernia is termed "strangulated." Because of the risk of tissue death (necrosis) and gangrene, and because the hernia can block food from moving through the bowel, a strangulated hernia is a medical emergency requiring immediate surgery. Repairing a hernia before it becomes incarcerated or strangulated is much safer than waiting until complications develop.
Surgical repair of a hernia is called a herniorrhaphy. The surgeon will push the bulging part of the intestine back into place and sew the overlying muscle back together. When the muscle is not strong enough, the surgeon may reinforce it with a synthetic mesh.
Surgery can be done on an outpatient basis. It usually takes 30 minutes in children and 60 minutes in adults. It can be done under either local or general anesthesia and is frequently done with a laparoscope. In this type of surgery, a tube that allows visualization of the abdominal cavity is inserted through a small puncture wound. Several small punctures are made to allow surgical instruments to be inserted. This type of surgery avoids a larger incision.
A hiatal hernia is treated differently. Medical treatment is preferred. Treatments include avoiding reclining after meals, avoiding spicy foods, acidic foods, alcohol, and tobacco, eating small, frequent, bland meals, eating a high-fiber diet.
There are also several types of medications that help to manage the symptoms of a hiatal hernia. Antacids are used to neutralize gastric acid and decrease heartburn. Drugs that reduce the amount of acid produced in the stomach (H2 blockers) are also used. This class of drugs includes famotidine (sold under the name Pepcid), cimetidine (Tagamet), and ranitidine (Zantac). Omeprazole (Prilosec) is not an H2 blocker, but is another drug that suppresses gastric acid secretion and is used for hiatal hernias. Another option may be metoclopramide (Reglan), a drug that increases the tone of the muscle around the esophagus and causes the stomach to empty more quickly. |
More information on hiatus hernia
What is a hiatus hernia? - A hiatus hernia is the protrusion of the stomach above the diaphragm. This condition may be a congenital disorder or the result of trauma.
What causes hiatus hernia? - Most hernias result from a weakness in the abdominal wall. A hiatal hernia may also be caused by obesity, pregnancy, aging, or previous surgery.
What are the symptoms of hiatus hernia? - Most people are not troubled by their hiatus hernia, but if reflux of the acid contents of the stomach occurs, you get heartburn.
How is hiatus hernia diagnosed? - The diagnosis of hiatus hernia is confirmed by barium meal X-rays or by passing a tube with a camera on the end into the stomach (gastroscopy).
What's the treatment for hiatus hernia? - Treatments include for hiatus hernia avoiding reclining after meals, avoiding spicy foods, acidic foods, alcohol, and tobacco, bland meals, eating a high-fiber diet. |
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