Hiatus Hernia

This is a condition where part or whole of your stomach moves into the chest. Normally the last inch to half an inch of the gullet is in your tummy, but due to a weakness in the opening of the diaphragm, through which the gullet passes from the chest into the tummy, the stomach moves into the chest.

Are there different kinds of hiatus hernias?

Largely speaking, there are two different types of hiatus hernias.

The commonest and most often diagnosed is a ‘sliding’ hernia. In this hernia, the top of the stomach ‘slides’ into the chest. This can be seen on an endoscopy. Small section of the upper stomach is seen above the level of the diaphragm.

The second and rarer variety is called a ‘rolling’ hernia. In this condition the stomach rolls into the chest. Varying amount of the stomach can herniate into the chest. Sometimes the whole stomach and bowel can be seen in the chest.

What symptoms can I get with a hiatus hernia?

The sliding hernias are mostly asymptomatic and often seen on endoscopy that was done for another reason. Sliding hernias generally do not give any symptoms, in particular they do not cause any pain. They may be seen in patients with heartburn / reflux, but may not be the cause for the symptoms. See heartburn section for further information.

The rolling hernias can be asymptomatic and picked up on scans or x-rays done for other purposes. But, they can give some significant symptoms. They can cause fullness and ‘indigestion’ even after small meals, reflux/heartburn, can cause vomiting and chest discomfort after meals, shortness of breath (as they can be compressing on the lungs and the heart).

What treatment will I need for hiatus hernia?

If it is a sliding hiatus hernia and you are not getting any symptoms from it, you will not need any treatment. However, if you have symptoms of heartburn or reflux, you may need some acid suppressing medication or surgery. See heartburn (hylerlink) section for further information.

Most of the rolling type of hernias will certainly need a surgical treatment as there is a chance that the stomach that has herniated into the chest may get blocked or twisted. In extreme emergencies, part or the whole of the stomach can die as a result of the blood supply to it is cut off due to an extreme twist (strangulation).

If you are worried that you may have a hiatus hernia, or have been diagnosed of one, book an appointment with Mr Jayanthi for further assessment of symptoms, further investigations if required and to discuss treatment options.

Gastric Sleeve

A gastric sleeve surgery is a restrictive procedure where the size of your stomach is reduced therefore limiting the amount of food you can eat which will help towards weight loss.

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Sleeve gastrectomy is a procedure, where the stomach is stapled. As a result, the stomach (which is ‘bag’ shaped) is changed into a ‘tube’. The capacity of the stomach is significantly reduced. This results in feeling full even after a small meal and hence reducing the volume of food eaten each meal time.

Furthermore, research has also shown that following this operation, hunger is suppressed. There is also evidence that all the obesity associated health problems improve significantly following sleeve gastrectomy.

Risks on this operation include that of leak from the staple line, injury to liver, spleen and bowel.

Mr Jayanthi performs this operation using keyhole techniques. The patient stays in the hospital for about 1-2 days following the operation.

Gastric Band

A gastric band involves dividing your stomach into two by placing a silicone band around the stomach therefore creating a small pouch at the top of your stomach (roughly the size of a golf ball).

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Adjustable gastric band is one of the commonest operations performed worldwide.

Why is it called ‘adjustable’?

Adjustable gastric band consists of a plastic ring with a balloon, which goes around the upper part of the stomach. This is connected to a port underneath the skin. The balloon in the band offers the ‘adjustability’. The band is filled with saline to cause a small gastric pouch above the band. This will make patients feel full even after small meals. The optimal amount of inflation or filling of the band varies with each patient. If the band is under filled you are able to eat more. On the other extreme you will not be able to swallow if the band is over filled. Therefore, it is important to achieve a happy medium. This can take anywhere from a few months to a year.

What are the risks?

This procedure is safe and most of the patients will be able to go home either later the same day or after overnight stay. There are however some risks as with any other operations. Specific to this operation, there is a chance of injury to the stomach, spleen and liver during the operation. Liver diet will go a long way to minimise the chances of injury to the liver.

The port site under the skin can get infected. This infection can then track down to the band and may only be treatable by removal of the band. Therefore careful aseptic technique should be employed while filling or de-filling of the band.

Slippage, erosion, infection

In the long run, there are chances of the band slipping over the stomach. This can result in vomiting, unable to swallow, and or weight regain. In some instances this can lead to the band eroding into the stomach. Patient can become very unwell as a result of the erosion. Urgent medical help from an expert is essential in this situation. The port can also get infected as a result of the erosion with the infection tracking from within.

How successful?

Overall, adjustable gastric band can achieve significant & sustained weight loss. Gastric band matches and in some cases can do better than a gastric bypass in terms of weight loss. Patient with diabetes can see improvements in the condition as they loose weight.

Gastric Bypass

In the UK, the most common gastric bypass surgery is a combination of restrictive and malabsorptive procedure procedures called Roux-en-Y (RYGB) which creates a two-way weight reducing effect.

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Gastric Bypass combines the effects of both restriction & a mal-absorption. In this operation, stomach is reduced in size and bowel is re-routed in a fashion that food bypasses stomach and enters small bowel (often called roux-en-Y).

Following Gastris Bypass, patients not only feel full even after small meals but their calorie absorption is decreased. Research has shown that, gastric bypass also results in a number of changes in the gut hormone signals. The collective effects of these changes include early satiety (feeling full) and decrease in hunger. This results in healthy eating and assist patients to loose weight effectively and more importantly results in sustained the weight loss.

Gastric Bypass improves all obesity-associated conditions. The effect on diabetes is most striking. Type 2 Diabetes improves almost immediately after Gastric Bypass. This effect on Diabetes is unique to Gastric Bypass (of all the weight loss operations). High blood pressure, high cholesterol, reflux, weak heart improve in over 90% of the patients after Gastric Bypass. A recent study has confirmed that heart condition also improves following gastric bypass. Quality of life improves with patients more active in their day-to-day life, at work and in society.

Risks of this operation include join leaks, injury to bowel, stomach, liver and spleen. Mr Jayanthi performs Gastric bypass using keyhole techniques. Patients can be discharged after 48hrs.

Hiatus Hernia

Are there different kinds of hiatus hernias?

What symptoms can I get with a hiatus hernia?

What treatment will I need for hiatus hernia?

Gastric Sleeve

Gastric Band

Gastric Bypass

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