About 15-20% of the population in Western countries will experience a hiatal hernia. Many people who have one may not even know it until the problem shows up on a scan, though. When this happens, patients want to know what size hiatal hernia needs surgery.
Several factors, including size, determine whether this condition requires surgical intervention. Check out these frequently asked questions to help you better understand your options if you have been diagnosed with a hiatal hernia.
What Size Hiatal Hernia Needs Surgery?
This is a complicated question without a definitive answer, because size is just one of the factors that determine if surgery is necessary. No hiatal hernia goes away on its own, and surgery is the only way to completely fix it. The question is whether you actually need surgery or if you can manage symptoms safely without it.
Of course, the size of the hernia and how much of the stomach that is involved are important. The main factor, however, is how much your symptoms affect your quality of life or if they become life-threatening.
What Is Considered a Large Hiatal Hernia?
Most doctors agree that hiatal hernias don’t need surgery if they are under 5 cm, which is considered small. In fact, even if you have a large hiatal hernia that reaches 7 cm, your doctor may not consider surgery necessary, especially if you aren’t experiencing any symptoms that affect your quality of life.
How Do You Know if Your Hiatal Hernia Needs Surgery?
The type of hernia plays into the need for surgery. There are two main types of hiatal hernias.
Sliding Hernia
Type 1, or a sliding hernia, happens when part of the stomach slides up in the chest cavity near the point where it connects with the esophagus, an opening in the diaphragm known as the esophageal hiatus. The majority of hiatal hernias fall within this category. Many of them remain small enough not to affect gastrointestinal function. Others may cause mild symptoms that patients can manage with lifestyle changes and don’t require surgery.
Paraesophageal Hernia
When a sliding hernia progresses, it becomes a paraesophageal hernia. Rather than just sliding near the hiatus, the stomach actually pushes up through it, widening the opening. This is what causes a lot of the associated symptoms.
At What Size Should a Hiatal Hernia Be Repaired?
As a paraesophageal hernia grows larger past 5-7 centimeters, it progresses through types 2-4:
- Type 2: The stomach pushes past the hiatus but not the diaphragm
- Type 3: Part of the stomach shifts above the diaphragm and into the chest
- Type 4: The esophageal hiatus becomes wide enough for other organs to potentially shift into the chest
Once the hernia grows large enough to compromise the hiatus, you will probably need to repair it.
What Are the Symptoms of a Hiatal Hernia?
Many hiatal hernias are either asymptomatic or are not large enough to cause serious gastrointestinal issues. Others, however, result in chronic gastroesophageal reflux disease.
Most people think of GERD as persistent or frequent heartburn, and that is the most common symptom. Several other symptoms may also indicate GERD or an underlying cause such as a hiatal hernia:
- Regurgitation
- Chest pain
- Nausea
- Difficulty swallowing
- Chronic hoarseness or persistent cough
If you are experiencing any of these symptoms, your doctor may order a chest CT to help identify the source of the problem. This is often how hiatal hernias are diagnosed.
How Do You Manage the Symptoms of a Hiatal Hernia?
A GERD-friendly diet is high in protein but low in fat. Focus on whole foods, and avoid highly processed snacks. Foods that are less spicy and acidic also tend to be gentler on the stomach.
Because you feel full faster when you have GERD, it’s better to eat four to five smaller meals or snacks throughout the day rather than a couple of large meals. It’s also a good idea to stop eating a few hours before bedtime so that there is no food in your stomach to rise back into your esophagus when you lie down.
Finally, there are a few lifestyle changes you can implement to ease your symptoms. If you are a smoker, GERD is a great reason to quit, making for one less irritation to worry about. Regular exercise helps your gastrointestinal system work more efficiently. Sleeping on an incline can reduce the likelihood that you will experience acid reflux while you rest.
What Happens During a Hiatal Hernia Surgery?
If your symptoms persist despite changes in diet and lifestyle, it may be time for testing to see if the size of your hiatal hernia needs surgery. This is typically a simple procedure that can have great long-term benefits.
Most hiatal hernia surgeries are laparoscopic procedures that don’t even require an overnight hospital stay. The process is straightforward:
- The patient goes under general anesthesia.
- The surgeon makes several incisions in the abdomen to insert the instruments used to perform the surgery.
- They move the stomach back to where it belongs under the diaphragm and stitch the hiatus back together.
- Mesh wrapping keeps the fundus in place.
You may need to take a few weeks off work to heal, depending on the advice of your doctor. You will likely be on a soft food diet for up to six weeks to allow complete healing of the surgical site. After this rest period is up, though, you may be surprised at how much better you feel and may be able to eat your favorite foods you never thought you’d experience again.
How To Know if the Size of Your Hiatal Hernia Needs Surgery
If you have persistent symptoms of GERD that won’t go away no matter how careful you are with your diet, there may be a significant underlying cause. The experts at Arizona Premier Surgery can advise on factors such as GERD symptoms and the size of hiatal hernia that needs surgery so that you can make the most informed choice for your long-term health.
Contact us when you are ready to discuss your options or if you have any questions about your upcoming procedure.
Sources:
https://www.ibihealthcare.com/hernia-repair/what-size-hiatal-hernia-needs-surgery/
https://www.healthline.com/health/what-size-hiatal-hernia-needs-surgery#hernia-size-and-surgery
https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/gastrointestinal-surgery/gi-surgeries/hernia-surgery/hiatal-hernia-surgery
https://ales.amegroups.org/article/view/5885/html
https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/symptoms-causes
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9264491/