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We asked Dr. Rohan, Phelps Hospital Northwell Health’s Westchester Regional Director of the Thoracic Surgery Program, to give us the 411 on hiatal hernias. Dr. Rohan specializes in minimally invasive chest surgery, which includes lung surgery, esophageal surgery, anti-reflux surgery and hernia surgery, among others. Here is what he had to say:
Q: What is a hiatal hernia?
Dr. Rohan: A hernia occurs when an organ squeezes through a weak area in muscle or tissue that surrounds the organ. With a hiatal hernia, the weak spot is in the diaphragm – the muscle between the chest and the abdomen. Depending on how severe the hiatal hernia is, part or all of the stomach can protrude through the diaphragm into the chest. Up to 10 percent of the population is reported to have at least a small hiatal hernia, and the risk of having this condition increases with age. There are several types of hiatal hernias, some of which do not need treatment. With the most severe type, other abdominal organs move into the chest along with the stomach.
Q: What are signs and symptoms of hiatal hernia?
Dr. Rohan: While many patients do not have any symptoms at all, the most common hiatal hernia symptom is acid reflux. When acid reflux is severe, there may also be respiratory problems such as chronic cough, asthma and shortness of breath. Other hiatal hernia symptoms include difficulty swallowing or painful swallowing as well as nausea.
Q: Do all hiatal hernias need to be treated?
Dr. Rohan: Most hiatal hernias do not require surgery. Often times, gastroesophageal reflux associated with hiatal hernias can be treated with diet adjustments or medications (proton pump inhibitors). Patients who have large hiatal hernias associated with difficult/painful swallowing or chronic nausea may be candidates for surgical repair.
Q: Can hiatal hernias be repaired with minimally invasive surgery?
Dr. Rohan: Yes. When surgery is recommended, a minimally invasive procedure to repair the hernia can be performed robotically. At Phelps, the latest daVinci Xi robotic system is used, with the most common method involving four or five small one-centimeter incisions. This surgery requires an overnight stay in the hospital, and most patients are back to their normal activities within two weeks. The use of the daVinci robot is associated with decreased risk of bleeding and less pain after the surgery as compared with conventional surgery.
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