Hiatal hernia

Are you looking for information regarding hiatal hernia and specialists for the therapy or operation? Here you will exclusively find experienced specialists and clinics in Germany, Switzerland or Austria. Learn more about causes, diagnosis and therapy or get in touch with our experts.

What is a hiatal hernia?

The term hiatal hernia refers to the displacement of portions of the stomach into the chest cavity. This involves a portion of the stomach being pushed through an opening in the diaphragm that in a healthy person is only passed through by the esophagus.

Such a hernia is not uncommon in our population. It is mostly discovered as an incidental finding during an X-ray.

There are two different types of hiatal hernia. The more common type is the "sliding hiatal hernia", where the junction of the esophagus and the stomach is incorrectly located above the diaphragm.

Another type is called paraesophageal hiatal hernia, which is when only a part of the stomach has been displaced upward. The transition of the esophagus and stomach, however, is still in its initial place.

What causes hiatal hernia?

A hiatal hernia can arise due to many causes. It can be congenital, for example, or result from injury, or be acquired over the course of a person's lifetime. Certain risk factors exist for the development of a hiatal hernia. Firstly, hiatal hernias occur more frequently in older people, as the elasticity of the connective tissue decreases and the muscles become weaker. Secondly, hernias may develop if the abdominal pressure is raised over a longer period of time, which may be the case, for example, with obesity or pregnancy.

Which symptoms are associated with a diaphragmatic hernia?

A diaphragmatic hernia has no symptoms in most patients. Nevertheless, symptoms may occur, for example chest pain and reflux complaints. Among the so-called reflux complaints are heartburn, feeling of fullness and upper abdominal pain. Furthermore, severe forms of hernia may cause complications such as bleeding in the gastrointestinal tract. If they occur frequently, they can lead to anemia as the disease progresses.

How is a hiatal hernia diagnosed?

There are several ways to diagnose a hiatal hernia. One possibility is to obtain an X-ray image of the patient's chest. An abnormal mass can then be seen on the film. It is the simplest method of diagnosis, but only makes sense if the hernia is large enough. For smaller hernias, usually an endoscopy, meaning a visualization of the esophagus up to the stomach, is used.

An alternative is the esophageal swallow test. In this radiological examination, patients are asked to drink a liquid containing a contrast medium, which allows the fluid in the patient's body to be traced. In this way, it is possible to determine whether the upper part of the stomach is located above or below the diaphragm.

Therapy: When should a hiatal hernia be operated on?

As a rule, a hiatal hernia is only treated if it causes symptoms. If there are symptoms such as heartburn and pain, they are usually first treated with drugs. Surgery, known as fundoplication, is only necessary if all other therapies fail and the symptoms continue to persist.

However, in the case of a paraesophageal hernia, surgery is recommended as the risk of complications is higher in this type of hernia.

Is diaphragmatic hernia surgery dangerous?

Today, hernia surgery is almost exclusively performed laparoscopically, i.e. through small abdominal incisions through which long surgical instruments are introduced. This eliminates the need to make a large abdominal incision, which can cause complications, making the surgery less dangerous. It is also shown that in most cases the operation is successful and in experienced hernia centers the mortality rate is less than 0.2%.

Hospital stay and follow-up care

Because no drains, or tubes for fluid drainage, or anything similar are placed during the operation, the patient can move freely again shortly after the operation without having to remain in bed. The average length of hospital stay after hernia surgery is about 3-5 days. Initial meals after surgery still consist of mushy and soft food. Then, after about 10 days, the transition to solid food is slowly initiated.

Follow-up visits are important because hiatal hernias can return despite the operation (as a so-called recurrence). During the first days after the operation, X-rays are obtained for monitoring to show any recurrences. However, even after several months or years, a follow-up visit may still be advisable to rule out recurrences.

Which doctors and clinics specialize in diaphragmatic hernia surgery?

If a diaphragmatic hernia has to be operated on, this is performed by visceral surgeons. They specialize in surgeries involving the abdominal organs. Among visceral surgeons, there are also specialized hernia surgeons who exclusively handle the treatment of different types of hernias. Such hernia surgeons can be found across Germany in many locations.

If you're in need of a doctor, you expect the best medical care possible. So of course patients are curious to find out what clinic to go to. As there is no objective way to answer this question and a legitimate doctor would never claim to be the best, patients must rely on a doctor's experience.

Let us help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in the field of hiatal hernias and are looking forward to your inquiry or wish for treatment.

Sources: 

• www.awmf.org/uploads/tx_szleitlinien/021-013l_S2k_Refluxkrankheit_2014-05-abgelaufen.pdf 
• www.uk-augsburg.de/kliniken-und-institute/klinik-fuer-allgemein-viszeral-und-transplantationschirurgie/schwerpunkte-und-leistungen/refluxchirurgie-und-thorax-magen.html 
• „Erfahrungen aus 12 Jahren chirurgischer Versorgung von 286 paraösophagealen Hernien“ veröffentlicht in „Der Chirurg“, online publiziert Juli 2015 
• www.amboss.com/de/wissen/Hiatushernie