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Hernia, a prevalent medical condition, occurs when a body part comes out through an opening into an area where it should not. A hiatal hernia occurs when the upper portion of the stomach protrudes into the chest cavity through a small opening in the diaphragm. This opening is generally large enough to accommodate the esophagus. Hiatal Hernia is also a common medical condition, and by the time people turn 60, almost 60 to 65% of the people have it.
Will Gastric Bypass Help Hiatal Hernia?
Types of Hiatal Hernia
There are two types of Hiatal Hernia –
The sliding-type: this occurs when the junction between the esophagus and the stomach slides up through the esophageal hiatus due to increased pressure in the abdominal cavity.
The fixed type: this means that there is no sliding upward or downward movement. A part of the stomach remains stuck in the chest cavity.
What Causes Hiatal Hernia?
The causes of the structural weakness that leads to Hiatal Hernia are still not very clear today. Some experts believe that the primary reason can be the pressure created on the diaphragm, and in many people, this risk is pretty high due to certain genetic factors.
Hiatal Hernia occurs in women during pregnancy. The fetus, which is growing, does tend to push the abdominal organs in an upward position. This rapid baby growth sometimes causes the organs to bulge through the diaphragm at the point where it meets the food pipe.
There can be some other causes and/or contributory factors to Hiatal Hernia, such as frequent coughing, poor seated posture, obesity, heavy lifting, and straining with constipation.
What are the symptoms of Hiatal Hernia?
For many people, the symptoms of Hiatal Hernia are almost non-existent. Many individuals recover from this medical condition without ever complaining of any symptoms. However, this is not true for all. The primary symptoms of this disease (that has been reported) include
- Difficulty in swallowing
- Heartburn
- Chest pain
- Coughing
- Belching
Hiatal Hernia also causes symptoms of discomfort when this gets associated with another medical condition that is known as GERD or Gastroesophageal reflux disease. GERD is mainly characterized by a weakened sphincter that acts as a valve between the stomach and the esophagus. Doctors believe that Hiatal Hernia dramatically contributes to the weakening of the sphincter muscle.
How is Hiatal Hernia treated?
In the majority of the cases, Hiatal Hernia can be kept under control just through simple medications and lifestyle changes that help to treat gastro-oesophageal reflux disease. There are several prescription and OTC medicines that help to ease the reflux symptoms associated with Hiatal Hernia. For example, antacids are very popular to combat Hiatal Hernia as they successfully neutralize the excess acid. However, acid production will never stop, and this means you cannot stop taking the antacids. The other types of medicines prescribed by the doctors are usually histamine blockers and proton pump inhibitors.
Is surgery required? When is it recommended?
Surgery is highly recommended for people with very large Hiatal hernias and for people who have symptoms that are not responding to any medications. If a person is suffering from severe hernia complications such as bleeding and/or obstruction of the esophagus, then the doctor will surely advise a surgery.
It is to be noted that surgery is almost not needed for sliding Hiatal Hernia. The rolling Hiatal hernias are likely to cause obstructions, and these might need corrective surgery. The type of surgery will depend upon the nature of Hernia and the related complications. The doctor is always the best person to discuss with the patient the benefits and risks (if any) of the surgery.
Which surgery is better – gastric sleeve or Rny (bypass)?
The gastric sleeve surgery is performed by making multiple incisions through which an experienced surgeon inserts laparoscopic instruments to perform this surgery. The patients are generally released two days after the surgery, although some hospitals have classified this surgery as a day-care procedure. This option is said to be a restrictive procedure as it limits the amount of food you can have at one time.
Many patients who have undergone this surgery had lost a significant amount of weight, and they never needed a 2nd procedure. Weight loss is the primary motive behind such operations as morbidly obese patients have been linked with medical conditions such as GERD, PCOS, and Hiatal Hernia.
An alternative to the sleeve gastronomy includes the Rny gastric bypass. Bypass surgery is the most common procedure that is followed in various parts of the world, including the US. This is also a restrictive procedure, and a person can lose up to 65% of the weight after the surgery. The gastric bypass surgery has immense benefits for diabetes patients.
Both the bariatric procedures – gastric sleeve and gastric bypass have a fair share of advantages and disadvantages. Although gastric sleeve ensures faster weight loss, the gastric bypass ensures quick correction of related co-morbidities such as diabetes. Again gastric sleeve surgery does not involve any dumping procedure as it is seen with gastric bypass, but this procedure involves the permanent removal of the stomach. But what puts gastric sleeve surgery slightly ahead of the gastric bypass surgery is that it is a set-and-forget procedure. The likelihood of any future problems with gastric sleeve is minimal. But this does not imply that Rny bypass leads to post-operative complications; it has its own set of advantages, including the fact that it is the best procedure available for people who have diabetes.
One needs to weigh a lot of factors before making a final decision on the type of procedure to be followed. The doctor will play a significant role in helping the patient understand the method that is most suitable for his medical condition.
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