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HIATAL HERNIA

UNDERSTANDING THE PROBLEM

When a part or whole of an internal organ (or tissues) protrudes through weak areas of the adjoining muscles or connective tissues, the condition is termed as a hernia. Hernia occurs through the weakened area, whenever there is increased pressure or strain on it. They most commonly occur in the abdomen region. A Hiatal Hernia occurs when the upper portion of the stomach (or any abdominal structure other than the oesophagus) enters into the chest cavity (thorax). It enters through the diaphragm, which is a muscular tissue separating the abdomen and chest. The word ‘hiatus’ means a gap in an anatomical region; in hiatal hernia, it is the diaphragm.

There are 4 types of Hiatal Hernias. The classification is important, because the indications for treatment differ with the different types.

  • Type I Hiatal Hernia: A sliding Hiatal Hernia occurs when the gastroesophageal junction (the part where the esophagus meets the stomach) slides above the diaphragm, along with the small top portion (cardia) of the stomach. This type accounts for about 95% of all the cases
  • Type II Hiatal Hernia: A fixed Hiatal Hernia occurs when part of the stomach (fundus) protrudes through the esophageal hiatus (the hole in the diaphragm through which the esophagus and vagus nerve pass through). The stomach and esophagus remain in the normal anatomical position below the diaphragm. This type accounts for about 5% of the cases
  • Type III Hiatal Hernia: This is a rare kind of Hiatal Hernia and is a combination of types I and II
  • Type IV Hiatal Hernia: This is another rare type that is associated with a large defect in the diaphragm, allowing other organs, such as the colon, spleen, pancreas, and small intestine, to enter into the chest cavity
  • Types II, III, and IV are called Paraesophageal Hiatal Hernias
UNDERSTANDING WHO SUFFERS
  • Hiatal Hernias become very common with increasing age. It is estimated that up to 70% of the adults over 70 years, may have Hiatal Hernia
  • Sometimes, it is a congenital (present at birth) condition and may be seen in children
  • Sliding Hiatus Hernia (type I) occurs at an earlier age than Paraesophageal Hiatal Hernias (types II, III, and IV)
  • Paraesophageal Hiatal Hernias are more common in women than men (ratio of 4:1)
  • It is noticed that Hiatal Hernias are generally more common in the developed nations because of chronic constipation, typically due to low-fiber diets
  • Even though there is generally no definitive cause for the occurrence of Hiatal Hernia, the following conditions may potentially result in it:
  • Increased abdominal pressure
  • Chronic or intense coughing
  • Extreme tension exerted during bowel movements
  • Pregnancy, labor, and delivery
  • Significant weight gain
  • Intense lifting (heavy weights)
  • Slouching or bending too much over long periods of time
  • Congenital weakness in the diaphragm or surrounding regions; or a large hiatus
POTENTIAL SIGNS AND SYMPTOMS

Most individuals with a small Hiatal Hernia do not present any symptoms. It is diagnosed by chance, during upper gastrointestinal diagnostic tests undertaken for other health reasons. Larger hiatal hernias may include the following:

  • Hiccups, burping, or belching
  • Heartburn
  • Bloating, fullness following a meal
  • Mild to major heartburn
  • Aching or painful chest region
  • Trouble swallowing
  • Chronic coughing
  • Chest and Abdominal Pain
  • Gastroesophageal reflux disease (GERD) symptoms such as bitter taste in the mouth, water brash (regurgitation of stomach contents), or even aspirating food contents into the lungs. In GERD, stomach acids and digestive enzymes flow up into the esophagus, due to a weak sphincter
  • Vomiting blood or passing black stools, which may indicate gastrointestinal bleeding

One should seek immediate medical attention, if any of the following symptoms occur:

  • Heart palpitations, racing
  • Shortness of breath or difficulty breathing
  • Blood in one’s vomit or stool
  • Black, dark, or tarry stools
  • Trouble with swallowing, both foods and/or liquids
  • Chest pain or intense pressure
  • In the case of a sliding Hiatal Hernia, if blood supply to the stomach is blocked (strangulation), it would cause extreme abdominal pain and potentially severe illness (shock). In such cases, an emergency surgery is necessary.
EXAMINATIONS USUALLY REQUIRED

There are many different tests that can be used to diagnose a Hiatal Hernia. These may include:

  • Complete medical history and a thorough physical exam
  • Esophago-gastro-duodenoscopy (EGD, a type of endoscopy): A thin flexible tube is pushed through the esophagus, to see the insides of the pharynx (throat), esophagus, stomach, and part of the duodenum
  • Barium swallow x-ray: It is a special type of x-ray in which the individual drinks a liquid (contrast barium) and series of x-rays are taken to visualize the contour of esophagus and stomach
  • High resolution manometry (HRM): A gastrointestinal (GI) motility diagnostic system that is used to measure the pressure activity within the upper gastrointestinal tract
  • Capsule pH test: During an endoscopy, a small capsule is attached to the bottom of the esophagus to record the amount of time it takes for the stomach acid to reflux back up into the esophagus, and also whether or not a heartburn actually occurs, during the reflux
PROPOSING TREATMENT AND WHY AIMIS

Surgery for Hernia Repair

If your doctor recommends surgery for a disorder, you may be a candidate for a minimally invasive approach - da Vinci Surgery. Because it is minimally invasive, the precision of robotic technology is ideal for delicate and complex surgeries around the chest and abdomen AIMIS is an expert in Robotic Surgery for Robotic Assisted Hernia Repair including for:

Inguinal Hernia - Herniorrhaphy, Hernioplasty - Inguinal, Surgical repair with/without grafts, Femoral Hernia - Femorocele repair; Herniorrhaphy; Hernioplasty – femoral, Surgical repair with/ without grafts, Umbilical Hernia - Surgical repair with or without grafts, Ventral Hernia - Surgical repair with grafts and Hiatal Hernia - Surgical repair with/without grafts, Nissen Fundoplasty

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for hernias and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Greater precision and Low rate of recurrence
  • Low rate of pain
  • Low conversion rate to open surgery
  • Low rate of major complications
  • Virtually scar less surgery with da Vinci Single Site Surgery®
  • High patient satisfaction
  • Reduced risk of blood loss
  • Shorter hospital stay

To see the procedures we undertake with Robotic Xi Surgery, please click here

GETTING MORE INFORMATION BEFORE MOVING FORWARD
YOU MAY HAVE QUESTIONS LIKE:
  • Can I get more information before I commit to this?
  • Can I get a second opinion from you before I commit to this?
  • How can I find out the cost before I have any obligation?
WHAT AIMIS CAN DO:

AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide.

AIMIS’ mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.

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AFFORDABILITY

AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.

 

FURTHER INFORMATION ON THE PROBLEM:

Most people with a hiatal hernia don't experience any signs or symptoms and won't need treatment. If signs and symptoms such as recurrent heartburn and acid reflux occur, treatment including medications or surgery may be needed.

  • Medications and lifestyle changes may be tried initially for mild symptoms, such as bloating or heartburn, of Hiatal Hernia
    • Weight loss programs if overweight or obese
    • Eating small frequent meals rather than few large meals
    • Eating 4 hours before sleeping or lying down
    • Elevation of the head end of the bed to keep the acid in the stomach (by gravity)
    • Medications for acid reflux include over-the-counter medications, such as antacids and ranitidine, or prescription medications such as omeprazole
  • If the stomach becomes strangulated (when blood supply to the stomach gets cut-off), or the symptoms from the hernia continue to worsen despite conservative approach, surgery may be necessary.
    • Most Paraesophageal Hiatal Hernias may need to be treated surgically
    • Most surgeries are minimally-invasive, performed through small incisions and done laparoscopically. The advantages of this type of surgery are faster healing process - with less risk of the wounds becoming infected, less post-operative pain, quicker recovery, and lesser scarring
    • Most often, these surgeries have a full recovery period of only 2-3 weeks. However, one should avoid lifting heavy objects for up to 3 months following surgery

      The complications of Hiatal Hernia could include:

      • GERD and its complications including erosive esophagitis (inflammation), stricture (narrowing), ulceration, and/or Barrett's esophagus. Barrett’s esophagus is a condition where the inner lining of the esophagus changes to that of the stomach lining, due to acid irritation
      • If Barrett’s esophagus is present for a long time, cancer of the esophagus can occur
      • Volvulus of stomach: This is a medical emergency. In this condition, the stomach rotates on its axis and in the process blood supply to the stomach gets cut-off, causing death of the stomach tissues
      • Obstruction of the portion of the organ that herniates into the chest
      • Perforation of esophagus
      • Anemia is common in paraesophageal hernias
      • Complications occurring outside the esophagus may include asthma, hoarseness, cough, chest pain, and/or aspiration
FURTHER INFORMATION ON INCREASED RISK GROUPS

Any factor that increases the abdominal pressure and/or any factor that causes weakness in the diaphragm and surrounding regions (ligaments) increase one’s risk of Hiatal Hernia. These factors may include:

  • Hiatal Hernia is more common with an advancing age
  • Smoking
  • Chronic abdominal stress due to chronic constipation, chronic coughing, etc.
  • Long-term use of drugs (such as cocaine)
  • Those with weak diaphragm or surrounding regions; or a large hiatus. The weakness may be genetically acquired
  • Pregnant women
  • Significant weight gain

Hiatal Hernia cannot be prevented from occurring as the exact cause and mechanism is not known. However, once diagnosed, the symptoms and progression of the condition can be prevented by observing the following measures:

  • Weight loss, if one is obese, is very important
  • Include more physical activities and exercise regularly
  • By undertaking less straining, leaning, or slumping, while performing everyday activities
  • Smoking cessation
  • Sleep at an angle on the bed, with the head raised around 4-6 inches
  • Maintain a healthy diet (by including high fiber) to avoid constipation
FURTHER EXAMINATION THAT MAYBE REQUIRED OR REQUESTED

Imaging (CT scan of abdomen and chest) and other tests may performed in emergency situations, if acute complications are suspected.

WHY AIMIS FOR THIS SURGERY

AIMIS is an expert in Robotic Surgery for Robotic Assisted Hernia Repair including:

Inguinal Hernia - Herniorrhaphy, Hernioplasty - Inguinal, Surgical repair with or without grafts, Femoral Hernia - Femorocele repair; Herniorrhaphy; Hernioplasty – femoral, Surgical repair with or without grafts, Umbilical Hernia - Surgical repair with or without grafts, Ventral Hernia - Surgical repair with grafts and Hiatal Hernia - Surgical repair with/without grafts, Nissen Fundoplasty
and other minimal invasive procedures involving the best American and International surgeons who are experts in the field.

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for Hernia Repair and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Greater precision and Low rate of recurrence
  • Low rate of pain
  • Low conversion rate to open surgery
  • Low rate of major complications
  • Virtually scar less surgery with da Vinci Single Site Surgery®
  • High patient satisfaction
  • Reduced risk of blood loss
  • Shorter hospital stay

Some procedures can be achieved through the belly button traditional single incision laparoscopy or da Vinci® Single-Site® Surgery. The da Vinci System features a magnified 3D high-definition vision system and flexible Single-Site instruments. These features enable your doctor to operate with enhanced vision and precision and provide virtually scar less surgery.

OTHER SERVICES PROVIDED BY AIMIS

In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.

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