In uncomplicated cases, lifestyle changes (e.g., weight loss, increasing dietary fiber, avoiding actions that increase intra-abdominal pressure) and acid-neutralizing medication may alleviate the symptoms associated with hiatal hernia. Initial treatment may include administering antacids and drugs (e.g., H2 histamine receptor blockers, proton pump inhibitors [PPIs]) that decrease stomach acid secretion. Medical therapy also may include drugs to increase esophageal and gastric motility. Elevating the head of the bed; avoiding large, late evening meals; avoiding highly seasoned foods, fatty foods, citrus juices, coffee, smoking, and alcohol; wearing loose-fitting clothing; and eating small, frequent meals, also may be beneficial in relieving symptoms.
Surgical intervention usually is limited to treating more serious complications, such as volvulus, strangulation, or pulmonary complications, but may also be done prophylactically to prevent such complications or in situations in which aggressive medical treatment with PPIs has failed to relieve GERD symptoms. If the individual requires surgery, the surgeon wraps the gastric fundus around the gastroesophageal junction (Nissen or Belsey fundoplication) and returns the stomach to the abdomen (mobilization) and sutures it in place. Surgery for paraesophageal hernia pulls the hernial sac back into the abdomen and reduces the size of the esophageal hiatus; sometimes the stomach is tacked down to prevent future migration. In many cases the surgeon can view the field through a fiberoptic camera and accomplish these procedures through small laparoscopic incisions in the abdomen. If this is not possible, a more generous surgical field is then provided through an open incision in the chest wall (thoracotomy) or the abdomen (laparotomy). Recovery time with an open procedure is longer, and risk of complications (e.g., bleeding, infection) is higher. |
Source: Medical Disability Advisor