ALO BARIATRICS Bariatric Center

Hiatal Hernia Repair and Bariatric Surgery

Nov. 23, 2015 by Dr. Alejandro Lopez-Ortega

Hiatal Hernia

In order to understand what a hiatal hernia is, we must understand a little about anatomy.

The diaphragm is the muscular wall separating the chest cavity from the abdominal cavity.

The hiatus is located in the diaphragm, is the opening where the connection of the esophagus and the stomach attaches

The lower esophageal sphincter (LES), keeps stomach contents from backing up into the esophagus (reflux).The hiatus normally has to be tight and small. If it is more open than it should be, an hiatal hernia is developed, the stomach m

oves up through the chest cavity.
This pushes the LES up, away from the hiatus and it loses the support that it needs from the diaphragm to stay closed. This raises the risk for symptoms of heartburn and gastroesophageal reflux disease.

Causes of Hiatal Hernia

Sometimes the cause is unknown. A person can born with a larger hiatal opening.
Also it can be caused by increased pressure in the abdomen such as from pregnancy, obesity, etc.

Who has more risk to develop Hiatal Hernia?

Hiatal hernias occur often in women, people who are overweight, and people older than 50.

Symptoms

Most people who have hiatal hernias don’t realize it because they dont feel any symptomatology.

Those who have Symptoms can include: heartburn, regurgitation, difficulty swallowing, chest pain, a bloated feeling after eating, Shortness of breath.

BARIATRIC SURGERY AND HIATAL HERNIA REPAIR

Hiatal hernia surgery can be performed as a laparoscopic, or “minimally invasive,” procedure.

Some surgeons prefer not to repair a hiatal hernia when they see it.

Yes, it is an additional procedure, it does requires additional time in the operation room and additional skills. In ALO Bariatrics the hiatal hernia repair is always done when found.

Dr. Alejandro López’s experience has shown us that if we leave unrepaired a hiatal hernia in a patient that is going through bariatric surgery, there’s a high risk to develop severe symptoms after surgery such as vomit or severe acid reflux, so we choose to repair the hiatal hernia when we find it for the well of our patients.

That way, in ALO Bariatrics, we know we are preventing our patients to have severe symptoms after surgery.

In one time in the operation room, ALO Bariatrics patient’s can have the two procedures done, the bariatric surgery and the hiatal hernia repair.

Some patients that had their procedures somewhere else that didn’t have the hernia repaired, had to go through another surgical procedure months after the bariatric surgery to have that hernia repaired because of the symptoms it caused to them.

For example, after gastric sleeve the pressure in the new stomach is bigger when food goes through because it is smaller. If there is a hiatal hernia, this pressure will make easier to develop vomit or reflux.

Also the diameter of the gastric sleeve is almost the same as the esophagus, so it can easier moves up to the chest cavity and increase the symptoms of reflux.

Dr. Alejandro López emphasizes the importance of hiatal hernia repair when found during a bariatric procedure. He also cites some articles that mention the importance of hiatal hernia repair, such as http://www.bariatricnews.net/?q=news/11907/hiatal-hernias-must-be-closed-most-sleeve-gastrectomies and http://www.ncbi.nlm.nih.gov/pubmed/22867558

After hundreds of cases that ALO Bariatrics team have had of patients who come to revision surgery that had their first bariatric procedure somewhere else, we realize that they have hiatal hernia. After that first procedure they had, they developed symptoms of severe reflux and didn’t lose enough weight, so in the revision surgery, Dr. Alejandro López had to repair the hiatal hernia and convert the failed procedure into another, for example from gastric sleeve to bypass.