​Hiatal Hernia​​

A hiatal hernia develops when the upper part of your stomach bulges up through your diaphragm and into your chest cavity area. The diaphragm is a large muscle which is located between your chest and abdomen and assists in breathing. Your stomach is meant to lie below the diaphragm, however if you have hiatal hernia, a portion of your stomach pushes through the hiatus (opening where the oesophagus connects to the stomach) of the diaphragm muscle. ​

Most cases of hiatal hernia are not a cause of concern, and you may not even be aware that you have one unless your doctor discovers it during a check-up. However, in other cases a large hernia may cause food and acid to build up in your oesophagus, which can cause heartburn. 

Symptoms from a hiatal hernia can usually be treated and alleviated through self-help measures. Yet very large hiatal hernias may require a surgical procedure to treat it.​

Small hiatal hernias most often do not cause any adverse signs or symptoms. Yet larger hiatal hernias may cause symptoms such as:

  • Trouble with swallowing

  • Heartburn

  • Pain in the chest or abdomen 

  • Feeling overly full after eating​​​​​

It is advised that you make an appointment with your doctor at the GI and Surgery Service Line​ at The Aga Khan University Hospital if you experience severe pain in your chest or abdomen, become nauseous, are vomiting, are having problems with your bowel movements or in passing gas. These may indicate you have a strangulated hernia or a blockage, which are considered medical emergencies and should receive immediate attention. 

Your time with your doctor maybe limited, so make sure to prepare for your visit beforehand. Here​ are some tips to help get you started.

It is quite common for a hiatal hernia to be discovered during a check-up or diagnostic tests for upper abdominal or chest pain or heartburn. Diagnostic tests may include:

  • Endoscopy – during the procedure, your doctor will pass a thin and flexible tube which has a video camera and light attached to it down your throat and along you oesophagus into your stomach to check for signs of inflammation. 

  • An esophagram – this test involves drinking a liquid which contains barium, which will assist your doctor to examine your oesophagus, stomach and duodenum (the upper part of your small intestine) displayed on an X-ray. 

  • Manometry - this procedure involves passing a catheter (a thin, pressure-sensitive tube) through your nose and along your oesophagus and into your stomach. The catheter is then able to measure and assess the movement in your oesophagus.   

Most cases of hiatal hernia do not cause any observable or noticeable symptoms, and these do not require treatment. If you do require treatment, non-surgical options include medication for heartburn, to reduce or block acid production or to heal the oesophagus. 

Conversely, if you are suffering from a paraesophageal hernia (when a portion of your stomach pushes thought the hiatus), this may cause a strangulation of your stomach, which can cut off the blood supply, in which case a surgery may be recommended. A hiatal surgery is performed to reduce the size of your hernia, put your stomach contents back to their original position or reconstructing the oesophageal sphincter.  

An open surgery involves one large incision in your chest wall or abdomen, through which your surgeon can access and mend your hernia. 

On the other hand, a laparoscopic hiatal hernia repair is considered a minimally invasive procedure. It involves small incisions in the abdomen though which your surgeon can insert a laparoscope (small tube with a light and a camera) and other instruments to repair your hernia. 

Both types of surgery have advantages and disadvantages. Your doctor can help you choosing better treatment option for you depending on your condition.

Please click here​ for some guidelines on “what to do before your surgery”
Please click here​ for some guidelines on “what to do on the day of your surgery”

The potential complications of a surgical hiatal hernia repair include:

  • Painful swallowing – dysphagia. However this complication is usually temporary and should subside within a few months after your surgery.

  • Pneumothorax – this complication describes when excessive air accumulates around the lungs. This may require temporary insertion of a drain into the chest.

  • Infection or bleeding 

  • In rare cases, internal organ damage

Please click here​ for some guidelines on “what to do on after your surgery”

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage.

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage.

The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.