Get Your Hiatal Hernia Fixed Right the First Time

Hernia centers best to avoid long-term pain, recurrence

3 Types of Chest Pain That Won’t Kill You

Imagine being a baseball player who gets to see just one pitch.

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That’s the situation facing most hernia sufferers who require surgery. This is a get-it-right-the-first-time situation (or else).

Now, double down on this scenario for seniors who are suffering from a specific type of hernia. Hiatal hernias are most often found in people in their 70s and 80s. Many are treated with medication. But, in the tougher cases, doctors recommend surgery.

“The absolute best time to get your hernia fixed, with the best chance of a great result, is the first time you get it fixed,” says Michael Rosen, MD, Director of Cleveland Clinic’s Comprehensive Hernia Center. “You want to go to somebody who’s a specialist and knows all the options, to decrease the chances of complications like chronic pain – or a recurrence of the hernia.”

Hernias are “a hole in something that allows things to poke through that typically should not,” Dr. Rosen says. Hiatal hernias are located in the diaphragm where the esophagus joins the stomach. They typically cause heartburn and reflux. If the hernia just makes you uncomfortable, doctors will treat it with medications, Dr. Rosen says.

But more serious hiatal hernias, also known as paraesophageal hernias, become larger over time and the stomach starts to rise farther into the chest. This sometimes causes significant chest pain after eating. It can even cause weight loss and bleeding, Dr. Rosen says. In those cases, surgery is usually needed, he says. It’s best to ask your doctor about treatment as soon as a hernia begins to cause discomfort. 

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Why that first ‘pitch’ is so important

So why is that first surgery so important?

An unsuccessful surgery is frustrating for the surgeon, but even more so for the patient because of the resulting poor quality of life. The symptoms bothering you in the first place return.

Risks associated with remedial surgery include recurrent heartburn, difficulty with swallowing, increased bowel symptoms and nerve damage. Working with an experienced surgeon is best for any hernia patient. But surgeries for recurrent hernias – especially in older patients – are even more complex and challenging.

If you reach the point where you need hernia surgery, it’s important to go to a comprehensive hernia center to get the best treatment. With expertise in both minimally invasive surgery and large comprehensive surgery, a dedicated hernia center helps ensure the operation is done right the first time, Dr. Rosen says.

Advances in minimally invasive surgery mean that, for many patients, hernia surgery is no longer a major operation that puts you in the hospital for a week to 10 days. Patients now typically go home within a couple of days, Dr. Rosen says.

No way to prevent hernias, but good general health can help

In most patients, the cause of a hernia is not known. An injury, straining or weakness in the area may contribute.

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Two other types of hernias can impact the elderly but are no more likely to occur later in life than at a younger age.

Inguinal hernias, which occur in the groin, are more common in men. They are typically associated with heavy lifting, constipation, and prostate issues that cause urination difficulty or increases in abdominal pressure.”They can cause a lot of pain and discomfort,” Dr. Rosen says. “There is no way to prevent any hernia – not [doing] heavy lifting wouldn’t prevent them.”

But once you notice a bulge in your groin that causes discomfort, he suggests patients see a physician. “Once you have a hole there, it will never go away on its own,” Dr. Rosen says. “Most of these hernias can now be fixed using minimally invasive techniques, with decreased post-op pain, and help folks return to regular activity levels a lot quicker.”

Ventral hernias, which occur in the abdomen, also exhibit a bulge and pain. “Those will not go away, either,” he says. “There’s no way to prevent them.” Having said that, Dr. Rosen adds, ventral hernias are more common in people who are obese, or who have diabetes or chronic smoking habits. “Being in general good health reduces the chances of those kinds of complications,” he says.

Sometimes doctors perform these surgeries laparoscopically and sometimes they reconstruct the entire abdominal wall. The latter provides two advantages, Dr. Rosen says. “It improves your functional outcome because you get your core muscles back, plus it improves the cosmetics because you end up with a flatter abdomen.”


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