Hiatal Hernia After Gastric Bypass (What it is, Complications and Treatment Options)

Developing a Hiatal Hernia after gastric bypass can be painful and dangerous, the good news is that it can be managed without surgery. Even if surgery is required, it’s straightforward with strong, lasting results.

Overall complications after bariatric surgery are pretty rare. Only about 4% of patients experience serious complications post-op. The surgeries are safe and outcomes are generally positive and “uneventful” (which is what you want).

However, it is major surgery, and complications are bound to arise in cases here and there. One in particular that can develop is called a hiatal Hernia.

What exactly is a hiatal hernia and should you be concerned if you have one?

A hiatal hernia is when part of the upper stomach protrudes (or herniates) into the thorax. This is done through a tear or weakness in the diaphragm to allow for the protrusion.

There are actually two types of hiatal hernias:

1. Sliding hiatal hernia
2. Paraesophageal hiatal hernia

The most common type of the two, and the one we are going to focus on, is a sliding hernia (around 95%). This occurs when the connection between the stomach and the esophagus “slides” up above the diaphragm, and often dragging part of the stomach into the chest.

The second type of hiatal hernia is the paraesophageal hernia (around 5%), also known as a fixed hernia. This is when a portion of the stomach actually pushes through the hole the esophagus passes through into the diaphragm.

This type of hernia can gradually increase in size which will lead to other issues and possible herniation.

Those highest at risk are people 50 years or older, pregnant, or obese.

Also, it appears that women are at higher risk to develop one compared to men.

What causes a hiatal hernia?

Unfortunately, doctors don’t really know why most hiatal hernias happen.

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However, it is believed that some of the causes can be from the following:

• Being born with a larger hiatal opening than usual (genetics)
• Injury or damage to the area
• Changes in your diaphragm as you age (natural causes)
• A rise in pressure in your belly, as from pregnancy, obesity, coughing, lifting something heavy, or straining on the toilet

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Since obesity is believed to be a cause of hiatal hernias, it’s common for gastric bypass and other bariatric patients to actually have a pre-existing hiatal hernia BEFORE they have surgery. It is only discovered during surgery since patients can be asymptomatic as it pertains to their hiatal hernia.

If it isn’t causing an issue there’s no reason for you to know about it.

What are the signs and symptoms to look out for?

• Pain in the chest
• Trouble swallowing
• Shortness of breath
• Vomiting blood
• Regurgitating food into your mouth

Any of these symptoms will cause discomfort and/or pain and you should seek medical attention if you are experiencing any of these on a recurring basis.

Symptoms left untreated can potentially lead to the development of GERD.

Hiatal Hernias and GERD after gastric bypass or sleeve gastrectomy

GERD stands for Gastroesophageal reflux disease and is the result of when stomach acid or bile comes up into the esophagus and damages the lining. The existence of a hiatal hernia can make GERD, or reflux, symptoms worse.

If you experience heartburn or acid reflux more than twice a week, then you might have GERD. You will feel a burning feeling in your chest, especially after eating and it can even worsen when lying down.

The most common relief from GERD is lifestyle and dietary changes, which would include bariatric surgery – specifically gastric bypass surgery.

It has been shown that only gastric bypass can help relieve the symptoms, whereas a sleeve gastrectomy can actually worsen the symptoms or have no improving effect.

GERD and hiatal hernias can coincide with one another and can cause constant discomfort and even pain.

GERD and hiatal hernias can coincide with one another and can cause constant discomfort and even pain.

Interestingly enough, GERD can be a side effect of a hiatal hernia, as a hiatal hernia can exacerbate reflux discomfort and problems.

In any case, both are not ideal – fortunately they can be fixed..

Following your bariatric surgery, you may experience one or even both. However, as you continue losing weight and living a healthier lifestyle, these can subside and eventually go away altogether.

For hiatal hernias, surgical intervention may be needed for severe cases to decrease further complications.

What to do if you have a Hiatal hernia?

Most hiatal hernias can be monitored and treated without surgery. However, the only way to cure one is through surgery.

If the hernia is small enough it can actually exist without medical intervention. It won’t ever go away but it can be managed if it doesn’t get bigger.

So it’s very possible to live comfortably with a hiatal hernia without it interfering with your everyday life.

Taking over the counter antacids, like Tums.

Histamine type 2 (H2) blockers like Pepcid and Zantac can help lessen the chance of heartburn which will lessen the chance that the hiatal hernia gets worse (bigger).

In more severe cases, your doctor may recommend you take a Proton Pump Inhibitor (PPI) which decreases the amount of acid in your stomach.

Although these are used for more severe cases, they are tolerated very well and the chances of side effects are relatively low.

The three main PPI options are Lansoprazole, Esomeprazole, and Omeprazole.

However, if the hernia becomes big enough, surgery could be needed to treat it and relieve these symptoms.

People who had a hiatal hernia at the time of their surgery, are at higher risk for recurrence following the repair post-op.

Behavioral modification to manage Hiatal Hernia and GERD

Certain foods should be avoided if possible when you have a hiatal hernia. This is due to the fact that certain foods can increase your chance of heartburn and ultimately lead to GERD:

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Some foods to avoid if you have a hiatal hernia and/or GERD:

• Spicy foods
• Chocolate
• Fried food
• Fatty food
• Acidic food like oranges or grapefruit
• Fruit juice
• Coffee
• Tea
• Carbonated drinks (energy drinks, soda)
• Alcohol

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Aside from avoiding these types of foods, you can also make some lifestyle changes to help alleviate or lessen the symptoms.

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These include:

• Avoid lying down for at least two hours after eating
• Elevate your head while you sleep
• Lose weight
• Eat smaller portions
• If you smoke, try and quit
• Avoid wearing tight-fitting clothing

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Chronic uncontrolled reflux can lead to serious health problems and should not be taken lightly.

Hiatal hernia complications if left untreated

Like with any problem, if left untreated it can lead to many other potentially serious issues.

The larger a hernia grows, the more likely it is to cause issues. It will also make it more difficult to fix if and when surgery is required.

This requires immediate medical attention.

Key takeaways

It’s important to know the signs to be aware of so you can get the appropriate help if you have a hiatal hernia.

Most hiatal hernias do not require surgery and can be properly monitored and treated with non-surgical methods.

Avoid trigger foods and make the appropriate lifestyle changes, including weight loss (shown to be most effective), to help relieve the symptoms and decrease the chances of worsening the condition.

Gastric bypass can help relieve the symptoms of a hiatal hernia and GERD, however, sleeve gastrectomy usually worsens or has no change in the situation and is not recommended for someone with severe cases.

So if you have had the gastric sleeve and have chronic reflux, a conversion to the gastric bypass may the route you need to take to end GERD symptoms and damage to the esophagus.