Treatment of Hiatal Hernia – Diet, Lifestyle, Medication, Surgery

Hiatal Hernia Treatment

Asymptomatic patients do not require any treatment for a hiatal hernia. The approach to treatment may depend on the severity of hiatal hernia symptoms and complications.

Diet and Lifestyle

Cases with only mild GERD symptoms may be managed with dietary and lifestyle measures as outlined in the Acid Reflux Diet. The main point include :

• Avoid lying down or sleeping immediately after a meal.
• Smaller frequent meals should replace large meals.
• Stop cigarette smoking.
• Avoid using tight clothing that constricts the abdomen
• Elevate the head end of the bed.

Medication

In moderately symptomatic GERD patients, drug therapy is recommended along with diet and lifestyle changes as mentioned above. The drug therapy targets suppression of the gastric acid secretion which reduces the injury to esophageal lining. This includes the use of :

• antacids
• proton pump inhibitors
• H2-blockers

Prokinetic drugs increase gastrointestinal motility and facilitate quicker emptying of the stomach. Patients with persisting symptoms after a 6-week acid suppression therapy require further evaluation. The medical management of symptoms of hiatal hernia patients with proton pump inhibitors and motility agents has dramatically reduced the number of patients requiring for surgical treatment.

Surgery

Surgery is recommended in severely symptomatic hernia patients, patients with serious esophageal injuries like an esophageal stricture and bleeding ulcers, and patients with Barrett’s esophagus. Patients not responding to medical therapy or with frequent relapses while on medication may also be considered for surgical management as an option.

Various surgical techniques are used to correct the hiatal hernia.

• Nissen fundoplication (360-degree wrap) is the surgical procedure of choice for most patients. The fundus of the stomach is wrapped around the lower end of the esophagus by laparoscopic surgery (preferred) or open surgery. This prevents the gastric acid reflux and the protrusion of the stomach through defect in the diaphragm. A partial fundoplication may be performed when the esophageal motility is not satisfactory. The newly evolved endoscopy based approaches have not been effective in management of hiatal hernia

• Laparoscopic paraesophageal hernia repair is reasonably safe and associated with fewer complications and recurrences than open abdominal approaches. Use of a synthetic mesh is limited by the occasional esophageal erosions, ulceration and strictures associated with its use. However the newly introduced absorbable biological mesh may be used in certain large hiatal hernias.

Complications of Hiatal Hernia Surgery

Related complications of a hiatal hernia surgery include pneumothorax, injury to liver, spleen or hollow visceral organs, paralytic ileus, difficulty in swallowing, retention of urine and incision wound infection. There is a 5% chance for failure of the surgery and persistence of the symptoms.

Article reviewed by Dr. Greg. Last updated on January 8, 2011