Dr Deepak Varma Gastro Surgeon Cochin

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Hiatus Hernia

The stomach prolapses through the muscular opening in the diaphragm separating the abdomen and the chest cavity. Hiatal hernias are often incidental discoveries and asymptomatic. They are not life-threatening unless they present with strangulation or gastric volvulus.

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Sliding Hiatal Hernia:

A sliding hiatal hernia is a very common type of hernia occurring when the oesophagus and the stomach slide into the chest through the hiatus. They move to and fro, are small in size and can cause heart burns or reflux symptoms.

Paraoesophageal Hernia:

Once the stomach makes its way into the diaphragm, it doesn't t slide out and stays fixed. In longstanding cases, it can result in blockage of blood flow to the stomach. When this happens, it is a surgical emergency which requires pulling back of the stomach into the abdomen and closing the defect in the diaphragm.

Causes And Risk Factors

  • Muscle weakening due to pregnancy or ageing
  • Obesity
  • Abdominal ascites
  • Acquired or congenital
  • Straining during bowel movements

Signs And Symptoms

  • Reflux of stomach contents into the oesophagus causes heart burns
  • Esophagitis and intermittent bleeding
  • Cameron ulcers
  • Incarceration can lead to persistent chest pain and vomiting
  • Epigastric pain
  • Belching
  • Trouble swallowing

Diagnosis And Tests

  • Barium upper gastrointestinal series liquid barium is ingested and x-rays are taken, which provide a clear view of the upper digestive tract. The location of the stomach is visualized to see if it protrudes through the stomach indicating hiatal hernia.
  • Oesophageal manometry oesophagal high-resolution manometry is used for a more accurate detection of hiatus hernia. It also detects oesophagal motility disorders which is a very common association of hiatus hernia.
  • Endoscopy Oesophagoscopy can readily diagnose hiatus hernia. It can also assess the size and the presence of any complications like Barret s oesophagus.


Barretts oesophagus Continuous exposure of the oesophagus to acid can cause changes in the lining of the lower end of oesophagus. This is a precancerous condition, if not treated in time can lead to the formation of cancer.

Gastric volvulus and strangulation These are emergency situations which require surgery. This results in cut off of blood supply to the displaced stomach. In rare situations, the part of the stomach might be removed.


Obstructed and strangulated hernias are medical emergencies as they may block blood flow into the stomach. Individuals suffering from a hiatal hernia will also have GERD.

Some surgeries for hiatus hernia are:

Nissen fundoplication laparoscopic procedure with low morbidity and short hospital stay. In this, a valve-like mechanism is made around the lower end of the oesophagus by wrapping the upper part of the stomach around it. This gives very good long-term results in individuals suffering from reflux disease.

Partial fundoplication 270 deg. Wrap reduces the incidences of gas, bloating and postoperative dysphagia

We offer laparoscopic surgery helping a quick postoperative recovery for patients with a hiatus hernia and medically unmanageable reflux disease.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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