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Hiatal Hernia After Gastric Bypass

Hiatal Hernia After Gastric Bypass

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      Gastric bypass is the second most common bariatric procedure performed in the world. While surgery is relatively safe, and it improves patients’ quality of life and health, some new problems may arise after surgery. How to deal with newly developed hiatal hernia post gastric bypass? What to do with small hiatal hernia diagnosed before surgery turned into a large hernia, causing significant symptoms? Read on to learn about hiatal hernia after gastric bypass, hernia symptoms, and hiatal hernia repair and treatment.

      Types of hernias

      A hernia is an abnormal opening in the muscle or tissue holding abdominal organs in place. The most common areas for hernias are the defects in the abdominal wall or groin area. Many patients develop so-called incisional hernias mostly from large open incisions. Hernias may also develop inside the abdomen. One of them is called hiatal hernia - the defect in the diaphragm, causing the stomach to herniate into the chest.

      Common hernia types:

      • Incisional hernia
      • Hiatal hernia
      • Inguinal hernia
      • Umbilical (belly button) hernia
      Woman surgeon performing surgery.
      As with any surgery, there are risks for complications, which include hernias. Sometimes, a hernia may be present before surgery. Surgeons may be able to fix a hernia at the same time as a bariatric procedure.

      Factors increasing risk of hernia

      Hernias are the result of a combination of factors. A hernia may develop because of muscle weakness inside the body or because of excess strain. Age-related changes in the body can cause weakness in muscle tissue. Obesity is also a risk for hiatal hernia. Excess weight leads to increased abdominal pressure. Hiatal hernias are more common in people over the age of 50 and those who are obese. They may develop quickly or may develop over a long period.

      Common causes of hernias:

      • Muscle weakness inside the body
      • Chronic constipation and strain with bowel movements
      • Heavy lifting
      • Constant and persistent sneezing or coughing
      • Pregnancy and obesity, which increase pressure on the abdomen
      Man lifting weights on a barbell.
      Heavy lifting can increase pressure and strain in the abdomen. Increased pressure is a potential cause of a hernia.

      Signs and Symptoms of a Hiatal Hernia

      The most common symptom of a hiatal hernia is a burning sensation in the throat and pain in the chest. This makes sense because a hiatal hernia involves the diaphragm and the stomach. The diaphragm is what helps keep acid from coming up from the stomach and into the throat. When there is a hiatal hernia (a hole or weakness in the diaphragm), it’s much easier for the acid to come up. This acid reflux into the esophagus is called GERD (gastroesophageal reflux disease).

      Patients often refer to GERD as “chronic heartburn.” Heartburn is a common symptom of GERD. The burning sensation is caused by the acid.

      Other common symptoms of a hiatal hernia include chest pain, abdominal pain, nausea or vomiting, and swallowing problems. Chest and stomach pain are also prevalent symptoms of a hernia after gastric bypass. Patients may experience the pain as burning, sharp, dull, or pulling. Stomach pain may be felt all over the abdominal area or may just be in the middle.

      Man holding his chest in pain.
      Sometimes, a hiatal hernia allows stomach contents to push into the esophagus. Patients often experience heartburn as a symptom.

      Hiatal Hernia Diagnosis

      While many bariatric patients will not suffer from hernias, it’s essential to get treatment if you are suffering. For some patients, hiatal hernias may not cause symptoms initially, but often cause problems over time. After a hernia has developed, it usually won’t go away without medical treatment. If left untreated, hernias can worsen and can get bigger. Extended time with an untreated hernia creates the potential for more serious medical complications.

      With hiatal hernias, doctors often observe the hernia over time and recommend medication. A doctor may be looking for the presence of a hiatal hernia or may find it by accident.

      Common tests and procedures used to identify a hiatal hernia include:

      • X-ray of the upper digestive system
      • Upper endoscopy, which allows doctors to view the esophagus and stomach with a camera
      • Measurement of the esophagus muscle contractions when swallowing
      Picture of a throat and chest x-ray.
      A hiatal hernia that is not causing symptoms may be discovered during a routine chest x-ray.

      Medical and Surgical Treatment

      There are a few different treatments for a hiatal hernia after gastric bypass. Typically, the patient’s symptoms help doctors determine treatment. GERD or heartburn may be treated with medications. More severe or prolonged symptoms may require surgery.

      Medications a doctor may prescribe for hiatal hernia symptoms:

      • Over the counter, antacids help to neutralize the stomach acid
      • Over the counter or prescription medications to lower or prevent acid production

      Medications can help combat stomach acid and may give the esophagus time to heal. If medications don’t work, a doctor may recommend surgery to repair a hernia.

      Surgeries for hiatal hernia:

      • Rebuilding weak muscle tissue
      • Pulling the stomach back into its proper place
      • Reconstruction of part of the esophagus or stomach entry point
      Person putting pills in a pill container.
      In many cases, over the counter medications and dietary changes are usually enough to provide symptom relief.

      Lifestyle and Home Remedies for Hiatal Hernia Symptoms

      Making a few lifestyle and habit changes may help patients control symptoms caused by a hernia. These tips may also help patients avoid a hiatal hernia after gastric bypass surgery.

      • Eat several small meals throughout the day - avoid large meals which can make symptoms worse
      • Avoid foods that trigger symptoms of heartburn such as fatty and fried foods, tomato sauces, alcohol, chocolate, and caffeine
      • Maintain a healthy weight to limit the pressure on internal organs and tissue

      Avoid making a hernia worse and reduce your risk with the following tips:

      • Lose excess weight
      • Drink adequate fluids and eat plenty of fiber to prevent strain during bowel movements and constipation
      • Avoid heavy lifting

      Discuss your weight loss plan and any concerns with your doctor and healthcare team. Remember: bariatric surgery is just a tool, while your new healthy habits are the key to your success.

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        Morgyn Clair, MS, RDN

        Author

        Morgyn is an RD specializing in weight management and surgical weight loss. She has a master's in clinical nutrition and dietetics, and currently works as a clinical dietitian in a physician’s office.

        Gintas Antanavicius, MD, FACS, FASMBS

        Medical Reviewer

        Dr. G is a co-founder of BariBuilder. A US-based expert surgeon with over 10 years of bariatric experience, he regularly publishes research in medical journals like SOARD, Obesity Surgery, etc.