Dr. Eisner Answers your GERD Questions: Surgery for Hiatal Hernia
_My doctor has recommended that I have my hiatal hernia repaired. I am waiting to see a surgeon. Is this a good idea, and what should I ask the surgeon? _
Although rarely necessary, at times, surgical repair of a hiatal hernia is the right choice in patients with gastroesophageal reflux disease. There are two types of hiatal hernia. In the much more common, sliding hernia, in which the stomach slides below the esophagus into the chest, medical therapy usually is very effective. The paraesophageal hernia, in which the stomach herniates next to the esophagus, is usually managed surgery. This is because of the potentially life-threatening complication of strangulation. When surgery is considered, it is best to see a surgeon that performs the procedure laparoscopically, if it is possible. Laparoscopic anti-reflux surgery involves reinforcing the valve between the esophagus and the stomach by wrapping the upper portion of the stomach around the lowest portion of the esophagus. Using only small incisions, a laparoscope and small instruments are inserted through the incisions, the abdomen is expanded with gas, and the surgeon operates while watching a television monitor. While the procedure may take longer than the old-fashioned open procedure, because of the lack of a large incision, time spent in the hospital and recovery time before one can return to work are dramatically shorter. At times, usually either because of difficult anatomy, obesity or scar tissue, the surgeon may find it necessary to convert the laparoscopic procedure to an open one. In addition to problems with anesthesia, potential complications include bleeding, infection and injury to nearby organs such as the esophagus, stomach and spleen. You should check with the surgeon as to how many of these procedures he performs, and his success rate.
_I have iron deficiency anemia and have been to a hematologist and gastroenterologist and have had multiple tests. I am now being told that it is due to my hiatal hernia. Is this possible? _
While rare, some patients with large hiatal hernias can develop small linear ulcerations within the hiatal hernia due to a pressure effect of the diaphragms rubbing the stomach lining against itself when the top part of the stomach moves through the diaphragm. These ulcerations, found in about 5% of patients with hiatal hernias have been named Cameron lesions. Usually, the degree of anemia not that severe and the bleeding is typically occult, only picked up on blood tests and at times by checking the stool for occult blood. At times, it can be severe, requiring blood transfusions. Treatment is usually with proton pump inhibitors, and at times, Carafate, to coat the stomach lining. It should be considered in all patients with hiatal hernias that develop iron deficiency anemia.
_I have a terrible burning sensation in my mouth. Can this be reflux? _
Burning in the mouth is very non-specific symptom. While multiple possible causes exist, reflux should be considered. Certainly if you have heartburn, it is likely to be due to reflux, but, even without heartburn, it is possible, and should be treated with high dose proton pump inhibitors for at least a month. Other conditions to consider when you have a burning sensation in the mouth are: dry mouth, yeast infections, nutritional deficiencies such as iron, zinc and B vitamins; anxiety, nerve damage, allergies, and medications. You should check with your primary doctor, as in addition to seeing a gastroenterologist, you will probably need to see a dentist, as well as an ear, nose and throat doctor.