REFLUX(GERD), HIATAL HERNIA, DIAPHRAGMATIC HERNIA

Gastroesophageal reflux disease or GERD is wehn the acid from your stomach comes back into the esophagus causing heartburn. Patients may experience:

• Burning sensation in your chest
• Difficulty swallowing
• A sensation of a lump in your throat
• Regurgitation of food
• Chest pain

In addition, long-standing GERD can cause pre-cancerous and cancerous changes to the esophagus. Adequately treating GERD is important for your long-term health.

There is a normal opening from the chest to the abdomen that allows the esophagus to pass through (“hiatus”).  When this opening is weakened through stretching or pressure, it allows the stomach to push into the chest, this is a hiatal hernia.

Many people with hiatal hernias do not experience any symptoms and treatment may not be necessary. However, some people with hiatal hernias can experience symptoms of gastroesophageal reflux disease (GERD). This can cause uncomfortable symptoms, including burning sensation in your chest, difficulty swallowing, a sensation of a lump in your throat, regurgitation of food, or chest pain. 

In addition, some hiatal hernias can cause your stomach to twist (volvulus) and/or cut off the blood supply to your stomach requiring emergency repair.

GERD or a hiatal hernia can occur in anybody, but you’re at an increased risk of developing GERD or a hiatal hernia if you are overweight.  Diet and eating habits can affect GERD while older individuals are more likely to acquire a hiatal hernia. 

There are several reasons why surgery to treat GERD may be the right choice for you.

• The most common indication for surgery is if your antacid medication isn’t controlling your symptoms.
• Many patients do not want to take antacid medications for the rest of their lives due to concern for side effects of the medications or risk of long-term complications from acid-lowering medications.
  • Side-effects may include increased risk for infections (including clostridium difficile and community acquired pneumonias) dementia, chronic kidney disease, osteoporosis/risk of fracture, interaction with anti-platelet therapy, small intestinal bacterial overgrowth, and micronutrient deficiencies (magnesium and vitamin B12).
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463334/
• If you have pre-cancerous changes in your esophagus (metaplasia or Barrett’s esophagus with or without dysplasia).
  • https://www.sages.org/publications/guidelines/guidelines-for-surgical-treatment-of-gastroesophageal-reflux-disease-gerd/
• If you have a hiatal hernia associated with your GERD.

There are several reasons why surgery to repair a hiatal hernia may be the right choice for you.

• The most common indication for surgery is if your antacid medication isn’t controlling your symptoms
• Many patients do not want to take antacid medications for the rest of their lives due to concern for side effects of the medications or risk of long-term complications from acid-lowering medications.
  • Side-effects may include increased risk for infections (including clostridium difficile and community acquired pneumonias) dementia, chronic kidney disease, osteoporosis/risk of fracture, interaction with anti-platelet therapy, small intestinal bacterial overgrowth, and micronutrient deficiencies (magnesium and vitamin B12).
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463334/
• Some patients have large hernias that cause bleeding or are at high risk for incarceration (getting stuck)- these hernias often require surgical repair before the condition worsens.

For patients with GERD that medical treatment has not been effective or is not their preference, surgery using a fundoplication can help relieve the symptoms.  Dr. Liang can perform this surgery using minimally invasive surgical approach (laparoscopic or robotic) and many patients can even return home the same day following surgery.  Patients find following surgery with Dr. Liang, their lives are transformed for the better.  Patients are able to eat the foods they love, drink caffeine, sleep better, and improve their quality of life.

For patients that develop symptoms of GERD with a hiatal hernia or other complications from a paraesophageal hernia, a simple operation can help. Surgery can restore the normal mechanisms that prevent acid from reaching the esophagus by reducing the hernia and repairing the hiatus. This is a challenging surgery with reported rates of recurrence of over 50%.  However, with a specialist such as Dr. Liang, success with surgery is dramatically improved. 

Dr. Liang is able to perform your surgery using minimally invasive approach (laparoscopic or robotic). Patients who undergo this surgery are able to return home the quickly and full recovery is possible within several weeks. Patients find following surgery with Dr. Liang, their lives are transformed for the better.  Patients are able to eat the foods they love, drink caffeine, sleep better, and improve their quality of life.