Hiatal Hernia Surgery in Dubai
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In a hiatal hernia, the above part of your stomach squeezes through a hole in the diaphragm, the muscular sheet between your chest and abdomen.
This muscular partition, the diaphragm, usually serves as a barrier between the chest and abdomen. Hernias occur when organs or tissues push through weakened areas in the muscle or surrounding tissues.
Hiatal hernias specifically occur at the esophageal hiatal, where the esophagus passes through the diaphragm. This type of hernia is common and typically evolves gradually due to prolonged stress and strain on the diaphragmatic opening.
What are the different hiatal hernia types?
Hiatal hernias are categorised into two primary types: sliding hiatal hernias and para oesophagal hiatal hernias. The sliding type (Type 1) is the most common, affecting most individuals. The other three types fall under the para-oesophageal category.
Sliding Hiatal Hernia (Type 1):
The most prevalent type, making up 95% of cases. The gastro-oesophagal junction and part of the stomach move up through the diaphragm’s hiatal and then return to their normal position.
Paraaesophageal Hiatal Hernias (Types 2-4):
Type 2: The upper part of the stomach pushes through the hiatal next to the oesophagus, creating a bulge, also known as a rolling hiatal hernia.
Type 3: Combines Type 1 and Type 2 elements, with the gastro-oesophagal junction and another part of the stomach bulging through the hiatal.
Type 4: The rarest and most severe, where the hiatal is wide enough for the stomach and another organ (e.g., intestines, pancreas, or spleen) to herniate through.
What are hiatal hernia symptoms?
Hiatal Hernia symptoms include:
Common Symptoms:
- Heartburn: Burning sensation in the chest, especially post-meal.
- Noncardiac Chest Pain: Recurring chest pain similar to angina.
- Indigestion: Early fullness and burning abdominal pain.
- Burping and Regurgitation: Food, gas, and acid rise into the throat.
- Difficulty Swallowing: Experiencing a sensation of something stuck in the throat.
- Sore Throat/Hoarseness: Due to acid irritation.
- Asthma, chest infections.
Other Signs:
Nausea Or Vomiting: From Stomach Compression Or Acid Overflow.
Shortness Of Breath: If The Hernia Compresses The Lungs.
Pressure/Pain: In The Upper Abdomen Or Lower Chest, Common In Larger Paraesophageal Hernias.
Hiatal Hernia Diagnosis
Dr Ashok Bohra, a hiatal hernia specialist in Dubai, will discuss the whole journey in detail. To make an objective assessment of your problem, the following diagnostic procedures are often used:
- Endoscopy: An endoscope is a slender, flexible tube equipped with a camera that is gently inserted through your throat to examine the inner lining of your esophagus and stomach for signs of a hernia. It will also help exclude Barrett’s Esophagus, a pre-cancerous change in the lining of the esophagus due to chronic reflux.
- Esophageal manometry: This involves inserting a thin tube into your esophagus to evaluate the pressure dynamics while you swallow, offering insights into any dysfunction or abnormalities.
- pH test: This test measures the acidity levels within your esophagus and helps gauge the severity of acid reflux, which is often associated with hiatal hernias.
- Barium swallow: You'll consume a contrast liquid that highlights your esophagus and stomach on X-ray images, aiding your doctor in visualising any abnormalities like a hernia, reflux and abnormal esophageal motility.
- CT scan: For large, complex, paraesophageal hernia a CT scan is sometimes recommended.
Treatment Options
Treatment for a hiatal hernia varies based on symptom severity and hernia type. Options include:
1- Lifestyle changes
For people with mild symptoms, lifestyle changes can often help relieve symptoms and prevent them from returning. These lifestyle changes include:
Consider weight loss (overweight/obese).
- Consider weight loss (overweight/obese).
- Eating smaller meals more frequently.
- Avoid foods that trigger your heartburn, such as spicy foods, fatty foods, and acidic foods.
- Avoiding alcohol and caffeine.
- Quitting smoking.
- Incline bed head 6-8 inches.
2- Medications
Medications can’t halt acid reflux but can lower stomach acid levels, reducing discomfort. Your doctor may recommend:
- Antacids: Weaken stomach acid.
- Proton pump inhibitors: Decrease acid production.
- Prokinetics: Strengthen the esophageal sphincter and aid muscle function, preventing acid backup.
3- Surgery
- Surgical intervention becomes necessary for larger hiatal hernias and persistent heartburn symptoms unresponsive to medication.
- It is not advisable to stay on PPI for long. Long term PPI usage has significant potential side-effects like chronic kidney disease, osteoporosis and fractures, deficiency of B12, Iron, Magnesium, and Clostridium Difficile infections. A slightly increased risk of dementia has also been reported. Hence, patients who are dependent on PPI should be evaluated for surgery.
- Surgery is indicated for giant para-esophageal hernias or intrathoracic stomachs due to the risk of strangulation of the stomach.
- Surgery can halt the progression of Barrett’s disease and sometimes reverse it.
Types of surgical procedures:
- Hiatal repair surgery: This procedure involves suturing and sometimes using prosthetic mesh to tighten the enlarged hiatal, preventing stomach herniation into the chest cavity. This is an essential part of the surgery.
- Fundoplication: Nissen Fundoplication is the commonest type of surgery. It involves wrapping the upper stomach (fundus) a full 360 degrees, around the lower esophagus, creating pressure to prevent reflux of stomach acid and food. It is effective for stabilising the stomach below the diaphragmatic hiatal and creating a new valve mechanism. In some patients a partial wrap is preferable (180 or 270 degrees). Your surgeon will advise which is the ideal wrap for you.
- Collis gastroplasty: This involves Lengthening the esophagus often necessary for more complex hiatal hernias resulting in esophageal shortening. Tissue from the upper stomach is used to extend the aesophagus.
What to expect?
Hiatal hernia surgery in Dubai is done laparoscopically and involves 5 small cuts. Expect 60 to 90 minutes for the average hiatal hernia repair. Larger hernia can take slightly longer. General anaesthesia keeps you comfortable throughout. Open surgery is rarely used now.
If you’re considering treatment, consulting a skilled Hernia Specialist in Dubai for laparoscopic hiatal hernia repair can provide you with expert care and lasting relief.
Recovery
After hiatal hernia surgery, expect an overnight hospital stay. You will be advised to follow a tailored diet. Avoid carbonated drinks for a few weeks.
Gradually return to daily activities like walking, stairs, and exercise. Your surgeon will provide personalised recovery guidelines based on your specific surgery.
Contact Dr Ashok Bohra for Hiatal hernia surgery in Dubai
For top-notch Hiatal hernia surgery in Dubai, consult Dr. Ashok Bohra, a leading Hiatal hernia specialist in Dubai. With a career spanning over 30 years, Dr. Ashok Bohra is a distinguished, board-certified general surgeon renowned for his expertise and dedication to patient care.
His outstanding skills and unwavering commitment position him as the premier surgeon in the UAE, making him the ideal choice for Hiatal hernia treatment.
