One of the most important things an individual can do when preparing to have gastric sleeve surgery is to educate themselves on potential complications. Knowing the possible risks and how to identify them can be helpful and promote better health in years to come following surgery.

Hiatal Hernia and Gastric Sleeve

A hernia occurs when there is a weakness in a muscle wall -abdomen or diaphragm, that allows an organ to push through the weakened area. Obesity is a risk factor for developing any hernia. Hiatal hernias occur when the stomach or intestines push through the diaphragm and into the chest cavity. Gastric sleeve patients may develop a new hiatal hernia or have worsening of pe-existing small unrepaired hiatal hernia.

Symptoms of Hiatal Hernia

There are several symptoms associated with hiatal hernia. Some of the most common include:

• Gastroesophageal Reflux Disease, also known as GERD, is the most common problem patients experience if they develop hiatal hernia after sleeve gastrectomy.
• Pain: It is often described as a tearing, burning, sharp, dull, and pulling pain.
  The initial pain may be felt when the muscles first rupture, which creates the hernia. The pain may first be mistaken as stomachache and may come and go with periods of pain than relief.  However, if the hernia is left untreated, the pain will increase in severity.
• Nausea and Vomiting: If the stomach becomes partially blocked, an individual may experience nausea and vomiting.
• Difficulty swallowing
• Chest pain
• Other symptoms: Shortness of breath, regurgitation of food into the mouth.

Diagnosing a Hiatal Hernia

Some measures for diagnosing a hiatal hernia include using an endoscope, which allows the physician to view the chest internally. Also, a barium swallow may be ordered. The barium, known as a “contrast medium,” makes abnormalities more apparent on an x-ray.

Although most bariatric surgery patients will not experience a hernia, it is still important to pay attention to symptoms, should they occur. If a hernia is left untreated, it can become more significant over time and will put more pressure on surrounding tissues. This increases the risk of more serious medical complications.

Hiatal Hernia and GERD

Gastroesophageal Reflux Disease, also known as GERD, is a digestive disorder that affects the esophagus and stomach. GERD occurs when the lower esophageal sphincter is weak or relaxes inappropriately, which allows the contents of the stomach to flow up into the esophagus.

Some physicians believe the presence of a hiatal hernia may cause increased weakening of the lower esophageal sphincter, therefore increasing the risk for GERD. Although many people with a hiatal hernia will not experience heartburn or reflux, the presence of a hiatal hernia may allow stomach contents to reflux more easily into the esophagus.

Hiatal Hernia Repair After Gastric Sleeve

For some individuals, reflux symptoms may resolve following weight loss and with medical management, such as using antacids for gastric acid suppression. A hiatal hernia can cause symptoms of GERD or can worsen them in individuals who already experienced reflux.

If a hiatal hernia develops after gastric sleeve surgery, surgical repair of the hernia could result in specific symptoms decreasing or being resolved altogether. During hiatal hernia repair, the stomach is returned into the abdominal cavity, and the defect in the diaphragm around the esophagus is repaired. This repair helps prevent abdominal contents from protruding back into the chest cavity.

Although hiatal hernia repair is an option for patients with a gastric sleeve, conversion to RY gastric bypass may need to be considered if symptoms are severe.

What Food Should You Eat?

Choosing foods that don’t produce much acid could help reduce the symptoms associated with a hiatal hernia.

Foods that produce less acid, such as foods that are not processed, are good options for individuals who have a hiatal hernia. High fiber foods can help reduce acid reflux symptoms, which can relieve hernia discomfort. Some foods that are good include:

• Beans and peas
• Green leafy vegetables
• Nuts and seeds
• Lean proteins
• Non-citrus fruits, such as melons and berries
• Whole grains
• Yogurt
• Plant-based milk, such as almond or soy milk

Foods that you should exclude include anything that would usually be avoided if you have GERD.  A few examples are:

• High sodium foods
• Chocolate
• Peppermint
• Spicy foods
• Fried foods
• Citrus fruits, such as oranges and limes

Conclusion

While not everyone who has gastric sleeve surgery will develop or have worsening symptoms of a hernia, it is still important to know the symptoms and when to seek medical attention. Education is always the first step to living a healthy life.