hiatal hernias

Q&A with Dr. Jonathan Kiev: What to know about hiatal hernias

Dr. Jonathan Kiev

A hernia is a medical condition that occurs any time an internal organ or tissue bulges into an area where it shouldn’t be. Hernias don’t always cause noticeable symptoms, but they can cause serious problems if left untreated.

In honor of Hernia Awareness Month, we sat down with Dr. Jonathan Kiev, a new cardiothoracic surgeon at UK HealthCare, to discuss a specific type of hernia called a hiatal hernia.

What is a hiatal hernia?

A hiatal hernia occurs when a portion of the stomach sneaks out of the abdomen above the diaphragm. This occurs fairly frequently and can cause symptoms of pain, heartburn and bloating depending on the size and location of the hernia. Most patients have no symptoms at all, and the hiatal hernia is only discovered incidentally during another test or procedure.

Why do hiatal hernias occur?

Hernias occur because of a weakness in the tissue. This can be caused by aging or even trauma, which may have caused a disruption in the abdominal wall layers. Pregnancy and obesity are known to contribute to the development of hiatal hernias, as well.

Can patients do anything to treat their hernia?

Generally, the answer is no, unless there are symptoms or if the hernia is large enough to require surgery. Patients who have heartburn or gastroesophageal reflux disease, or GERD, are given medications once they are evaluated by their physician to be sure that there are no other more serious medical conditions.

When is surgery for hiatal hernia necessary?

If the symptoms are disabling, like the person is having difficulty swallowing or they’re having food get stuck after eating, then surgery is appropriate. If a patient is anemic – a condition where their blood doesn’t have enough healthy red blood cells – sometimes the hernia can be the cause of anemia, and this can be relieved with surgery, as well. Rarely, a large hernia can become trapped, and emergency surgery is necessary to relieve the constriction.

How is a hiatal hernia diagnosed?

Beyond a good health history and physical exam, a physician may order a swallowing test with dye or a CAT scan to see if the stomach is above the diaphragm. Specialized tests by a gastrointestinal doctor might include an endoscopy, which looks at the lining of the esophagus and stomach for evidence of acid that may cause irritation.

What can patients expect if they need surgery?

Surgery can be done through the abdomen or the chest. Thankfully, today’s techniques allow the procedure to be performed with tiny incisions in a couple of hours so recovery is quick and pain is minimal. Most patients go home in a day or two and recuperate over the next several weeks.

Most patients go home in a day or two and recuperate over the next several weeks. Surgeons that specialize in minimally invasive procedures and thoracic surgeons are experts in the repair of hiatal hernias. Your physician can refer you to a surgeon in your area.

Are dietary changes necessary after surgery?

Patients can still eat all the foods that they enjoy, although they may be encouraged to modify their intake and meal frequency.

Is a follow-up necessary after this surgery?

Surgeons like to follow their patients closely to be sure that these hernias don’t come back. We know that the larger hernias have a higher likelihood of recurrence, and special procedures are done to minimize this. Overall, the results of this surgery are excellent, and patients are very satisfied afterward.


Next steps: