4 Hernia Clinics | Walnut Creek, Concord, Antioch, & Brentwood
July 15, 2023

What Size Hiatal Hernia Needs Surgery?

If you're dealing with a hiatal hernia, you may be wondering at what point surgery becomes necessary. Hiatal hernias occur when part of the stomach protrudes into the chest cavity through the diaphragm. While all hiatal hernias might not require surgery, the size of the hernia plays a significant role in determining the need for surgical intervention.

In this article, we will explore the factors that influence the decision to undergo surgery for a hiatal hernia, with a specific focus on the size of the hernia. 

Types of Hiatal Hernias

A hiatal hernia occurs when a portion of the stomach protrudes through the diaphragm into the chest cavity. There are two primary types of hiatal hernias:

Sliding Hiatal Hernia:

Sliding hiatal hernias are the most common type, accounting for approximately 95% of all hiatal hernia cases. 

In a sliding hiatal hernia, the gastroesophageal junction and a portion of the stomach slide upward into the chest through the hiatus, a natural opening in the diaphragm that allows the esophagus to pass from the chest to the abdomen. 

This type of hernia is called "sliding" because the gastroesophageal junction and stomach can move back and forth between the chest and abdomen.

Paraesophageal Hiatal Hernia:

Paraesophageal hiatal hernias are less common but tend to be more serious.

In a paraesophageal hiatal hernia, the gastroesophageal junction remains in its normal position, but a portion of the stomach pushes through the diaphragm and lies beside the esophagus. 

This type of hernia can cause the stomach to become trapped or "incarcerated" in the chest, leading to potentially serious complications such as strangulation or obstruction of the blood supply to the stomach. 

It's important to note that hiatal hernias can vary in size, ranging from small and asymptomatic to large and causing significant symptoms. The size of the hernia, along with other factors, plays a role in determining whether surgical intervention is necessary

Determining the Size of Hiatal Hernia

When assessing the severity of your hiatal hernia and determining the appropriate treatment approach, healthcare professionals employ various diagnostic methods to accurately measure and classify the size of your hernia. The two most common techniques used for this purpose are:

Radiographic Evaluation: 

  • Barium Swallow X-ray: You will be asked to swallow a contrast material containing barium, which helps visualize your esophagus and stomach on X-ray. The radiologist can identify the herniated portion of your stomach and measure its size relative to the diaphragmatic opening.
  • Computed Tomography (CT) Scan: CT scans provide detailed cross-sectional images of your chest and abdomen. These scans accurately determine the size and location of your hiatal hernia and assess any potential complications or associated conditions.

Endoscopic Assessment

  • Upper Endoscopy (Esophagogastroduodenoscopy or EGD): During an EGD procedure, a thin, flexible tube with a camera (endoscope) is inserted through your mouth and into your esophagus and stomach. This allows the gastroenterologist to directly visualize your hiatal hernia and assess its size and any signs of inflammation or damage to your esophagus.
  • Endoscopic Ultrasonography (EUS): In some cases, an EUS may be performed during the endoscopy to obtain more detailed images of your hiatal hernia and surrounding structures. EUS can help assess the thickness of the hernia wall and detect any potential complications.

The size of your hiatal hernia is typically classified as follows:

  • Small Hiatal Hernia: The herniated portion of your stomach is relatively small and remains mostly in the abdominal cavity. These hernias are often asymptomatic or cause mild symptoms.
  • Moderate Hiatal Hernia: The herniated portion of your stomach extends partially into the chest cavity. Moderate hiatal hernias may cause more noticeable symptoms and can benefit from medical management.
  • Large Hiatal Hernia: The herniated portion of your stomach is significantly enlarged, and a substantial portion of your stomach resides in the chest. Large hiatal hernias are more likely to cause severe symptoms and complications, requiring careful evaluation and potential surgical intervention.

Your healthcare provider will consider the size of your hiatal hernia, along with your overall health, symptoms, and other relevant factors, to determine the most appropriate treatment plan for you.

Surgical Treatment Options

Surgical treatment options for hiatal hernias include:

  • Laparoscopic Repair with Mesh: Laparoscopic surgery is a minimally invasive approach that uses small incisions and a camera-guided instrument to repair the hiatal hernia. During the procedure, a mesh is often used to reinforce the weakened diaphragmatic opening, reducing the risk of hernia recurrence. This technique offers several benefits, including smaller incisions, less pain, faster recovery, and reduced scarring.
  • Open Repair Surgery: Open repair surgery involves making a larger incision in the abdomen or chest to access and repair the hiatal hernia. This traditional approach allows for direct visualization and manipulation of the herniated tissues. Open repair surgery may be necessary for complex or larger hiatal hernias that cannot be effectively addressed using laparoscopic techniques.

The choice of surgical technique depends on factors such as the size and complexity of the hiatal hernia, the surgeon's expertise, and your individual circumstances. Your healthcare professional will evaluate your condition and recommend the most appropriate surgical option for you.

Factors Influencing the Decision for Surgery

Several factors play a role in determining whether surgery is the appropriate treatment option for a hiatal hernia. These factors include:

  • Symptom Severity and Frequency: If you experience severe or frequent symptoms such as persistent heartburn, regurgitation, chest pain, difficulty swallowing, or respiratory issues, despite trying conservative management options, surgery may be considered.
  • Complications or Risk Factors: The presence of complications related to your hiatal hernia, such as recurrent strangulation, chronic anemia, Barrett's esophagus, or large paraesophageal hernia, may warrant surgical intervention. Additionally, certain risk factors like obesity or a history of previous failed repairs can influence the decision for surgery.
  • Age and Lifestyle: The age of the patient and their lifestyle preferences can also influence the decision. Younger, active individuals may prefer surgical intervention to avoid long-term reliance on medications, while older patients may weigh the potential benefits against surgical risks.

In conclusion, it is important to have a comprehensive evaluation by a healthcare professional to determine the most appropriate treatment option for your specific case.

If you are considering hiatal hernia surgery, reach out to us at Hernia Innovations. Our team of experienced surgeons specializes in hiatal hernia repair and utilizes advanced techniques to optimize outcomes and minimize discomfort.

Take the next step towards relief and improved quality of life by scheduling a consultation with Hernia Innovations today. Our dedicated professionals will guide you through the treatment process and provide personalized care tailored to your needs.