Gas bloat syndrome when the stomach fills up with air or food and you are unable to relieve the pressure.

Difficulty eating within the first month.

Recurrence especially high in the case of hiatal hernias.

Post-operative complications in surgery could include. Surgery could sometimes be dangerous, so watchful waiting may be advised. Small clips are put in place at the gastroesophageal junction to prevent food and stomach acid from refluxing. An endoscope with a camera is sent down though the mouth into the esophagus. In endoluminal fundoplication, no incisions are made. The surgeon does the procedure while looking at the inside of the belly with a video monitor that is connected o the laparoscope. In the laparoscopic repair surgery, 3 to 5 small cuts are made on the belly through which a tiny tube with a camera at the end and other surgical tubes are inserted. The tube is removed a week after the surgery. In the open repair surgery, a single large surgical cut is done on the belly and a tube is inserted into the stomach. It can be performed laparoscopically in which case there are lower complication rates, quicker recoveries, and relatively good long term results. This also reinforces the closing of the lower esophageal sphincter so that gastric acid reflux is prevented. In this procedure, the upper part of the stomach is wrapped around the lower part of the esophagus and secured with a mesh so the stomach does not herniate upwards. The most common surgical procedure is Nissen fundoplication. Any hernia with unrelenting symptoms or complications is an indication for surgical repair. In para-esophageal hernia it is the first-line procedure. This might cause chronic acid reflux and the cells in the walls of the esophagus could get damaged. When the hiatal hernia is huge or when it is of the para-esophageal type, the esophagus gets narrowed or tightened and swallowing becomes difficult.

Over-the-counter antacids that neutralize stomach acid.

H2 receptor blockers reduce acid production are cimetidine, famotidine, nizatidine and ranitidine.

Proton pump inhibitors that block acid production and heal the esophagus are lansoprazole and omeprazole.

Medicines help to reduce the entry of stomach contents into the esophagus (gastro esophageal reflux). Medications that strengthen the lower esophageal sphincter should be avoided.

If the cause is being overweight, weight loss is indicated. When there is pain or discomfort at night due to acid reflux, patients should keep their head raised in bed and avoid lying down immediately after eating. If no symptoms like pain or discomfort are present, no treatment is required. This is referred to as intrathoracic stomach. The end stage of hiatal herniation involves total herniation of the stomach into the chest by rotating 180 0. Type 4: Other organs like the colon, small intestine, pancreas and spleen also herniate into the chest cavity along with the stomach. Hence, it is a combination of type 1 and type 2. Type 3: Majority of the para-esophageal hernias belong to this type where the gastroesophageal junction is herniated above the diaphragm and the stomach herniates next the esophagus. If more than 30% of the stomach goes into the chest cavity, it is called a giant para-esophageal hernia.

The gastroesophageal junction remains in its place below the diaphragm while the stomach rotates itself and herniates into the chest cavity next to the esophagus. Type 2: Also known as para-esophageal or rolling hiatal hernia, it accounts only for 5% of all hiatal hernias but causes the most complications. It is a risk factor for gastroesophageal reflux disease (GERD), a digestive disorder. A part of the gastroesophageal junction (the junction containing the part of the esophagus that connects to the upper part of the stomach) herniates into the chest cavity in this type. Type 1: Also known as sliding hiatal hernia it accounts for 95% of all hiatal hernias.

Type 3 hiatal hernia