Large Hiatal Hernia: How Can It Be Treated Effectively?

A hiatal hernia is a different kind of hernia, as it occurs inside the abdomen. The main factor behind the development of a hiatal hernia is the loosening of the lower esophageal sphincter caused by gastroesophageal reflux. This is why hiatal hernia and gastroesophageal reflux are two closely linked conditions. But how is a large hiatal hernia treated? Dr. Konstantinos M. Konstantinidis MD, PhD, FACS, MAMSE explains how robotic surgery can treat even the most demanding cases.

What is a hiatal hernia?

A hiatal hernia is a different kind of hernia in which part of the stomach pushes up through the diaphragm into the chest cavity.

Types of hiatal hernia:

1. Type I (Sliding): The stomach and the lower esophagus move upwards through the opening (hiatus). It is a small hernia without symptoms. The main symptom of a sliding hiatal hernia is gastroesophageal reflux.
2. Type II (Paraesophageal): Part of the stomach (the fundus) moves above the diaphragm. It is considered the most dangerous type, as it can lead to impaired breathing, bleeding or twisting of the stomach (volvulus).
3. Type III (Mixed): A combination of the two types above, in which both the esophagus and the stomach move towards the chest.
4. Type IV (Giant): Not only the stomach but also other abdominal organs, such as the large bowel, can enter the chest cavity (large hiatal hernia)

What is a giant or large hiatal hernia?

A giant or large hiatal hernia develops mostly in older age and causes severe symptoms, such as:

• Heart-related symptoms
• Shortness of breath
• Chest pain

A large hiatal hernia can develop because of:

• Weakening of the muscle tissue with age
• Increased pressure in the abdomen
• Injuries or previous surgery
• Chronic cough

Symptoms of a large hiatal hernia

The most common symptoms of a large hiatal hernia are:

1. Heartburn and gastroesophageal reflux
2. Chest pain or pressure
3. Difficulty swallowing (dysphagia)
4. Feeling full after small meals. Complications:
5. Incarceration: This happens when part of the stomach becomes trapped in the chest cavity, causing sharp pain and possible obstruction.
6. Strangulation: A serious complication that occurs when the blood supply to the trapped stomach is cut off, leading to ischaemia or necrosis, which requires immediate surgery.

How is a large hiatal hernia treated?

When the hiatal hernia is small or causes no symptoms, laparoscopic surgery can be used as the procedure of choice. The same does not apply, however, to giant hiatal hernias. Treating a large hiatal hernia is a challenge and, because such cases are rare, it cannot be managed laparoscopically.

Robotic surgery, with its advanced navigation system, has provided a solution even for the most difficult and rare cases. Using the Da Vinci robotic system, the surgeon can repair a large hiatal hernia with exceptional precision, significantly reducing blood loss.

What are the benefits of robotic surgery in treating a large hiatal hernia?

• Minimally invasive method
• Fast recovery and less pain
• No blood loss
• Lower chance of complications
• Quick return to daily life
• High success rates

A large hiatal hernia can seriously affect patients’ quality of life, but with robotic surgery as an ally, even difficult cases can be treated. If you have symptoms or have been diagnosed with a hiatal hernia, contact Dr. Konstantinos M. Konstantinidis MD, PhD, FACS, MAMSE for a full diagnosis and a personalised treatment approach.