Hiatal hernia: Minimally invasive surgery makes a big difference

Though hiatal hernias are more common in older adults, they can occur at any age and will grow worse over time. At St. Mary Medical Center, a minimally invasive repair technique offers low risk to the patient with the potential for a vastly improved quality of life.

First, what is a hiatal hernia?

A hiatal hernia is a condition in which part of the stomach pushes up through an enlarged opening in the diaphragm muscle and enters the chest cavity. A small hiatal hernia can go unnoticed, but as it becomes larger it can cause food and acid to back up into the esophagus. Eventually, this can lead to gastrointestinal, pulmonary and even cardiac issues.

What are the symptoms?

“Patients initially have heartburn or reflux,” says Alfred C. Trang, MD, a board-certified surgeon who specializes in bariatric, foregut and hiatal hernia surgery. “They go to their primary care physician and are usually given an antacid. Early on, it does tend to control the symptoms.”

But as the hernia worsens, “more of the stomach will slide up into the chest and cause more symptoms,” Dr. Trang says.

Here are some of the symptoms of an advanced hiatal hernia:

• Early satiety. “When your stomach is in your abdomen, it can expand but the part of your stomach that’s in your chest is limited by your rib cage,” Dr. Trang says. As a result, patients will feel full more quickly and may reduce their food intake.
• Intermittent nausea and vomiting. “Food will have a harder time entering the lower stomach in your abdomen, so you’re going to feel queasy and possibly vomit,” Dr. Trang says.
• Shortness of breath/fatigue/intermittent chest pain. With a hiatal hernia, your stomach essentially becomes “a third roommate” in your chest, Dr. Trang says. That means your heart and lungs don’t have as much room to pump blood and oxygen through your body.

Hiatal hernia symptoms may develop over a period of years, so patients often assume that those symptoms are simply byproducts of getting older, Dr. Trang notes. However, as patients continue to lower their food intake to manage their symptoms, they will likely lose weight, become frail and will be at higher risk for pneumonia and other infections.

“Come in and see me,” Dr. Trang says. “I’ll work it up and figure it out for you.”

What’s the treatment?

Surgery can bring your stomach back into your abdomen, close the opening it had pushed through and reinforce the weakened tissues around the opening. Historically, Dr. Trang says, surgery for hiatal hernia carried significant risk, which made primary care providers reluctant to refer patients for the procedure.

However, at St. Mary, Dr. Trang uses a minimally invasive robotic technique that carries much lower risk—even for elderly patients. “The robotic platform is very delicate and precise,” ideal for working in a small space surrounded by vital organs, Dr. Trang says. “The key with operating on elderly patients is to minimize stress to the body—bleeding, inflammation and pain.” Robotic surgery helps to achieve that.

What’s the recovery like?

“Patients have hardly any pain after the surgery,” Dr. Trang says. “It’s less painful than gallbladder surgery. I’ve had patients in the recovery room asking me if they can go home.”

While Dr. Trang does keep patients overnight for observation, he estimates that some 90% of them are ready for discharge the next day.

Over time, the surgery can have amazing outcomes for patients, Dr. Trang reports. Patients can eat normally and gain weight again to restore vitality, improve quality and potentially extend their life.

Learn more, request an appointment, or call 215.710.6613.