Hiatus hernia surgery –
Preparatory investigations

As well as taking a detailed medical history and carrying out an assessment of the symptoms, specialist investigations can be used to provide information as to whether the surgical technique is an appropriate option in the individual’s specific case. The investigations required will depend on the patient’s status at initial assessment, the clinical picture, and the indication for treatment. The doctor will come to a decision for each patient on an individual basis. They will explain how the diagnostic tests will be performed and can answer any questions in detail.

Endoscopy

Using an endoscopy (camera test) of the oesophagus, it is possible to visualize any changes to the inner wall of the oesophagus. This procedure involves passing a thin flexible tube into the nose or mouth, and down via the oesophagus to the entrance of the stomach. There is a minute camera at the tip of the tube which records images of the mucosa in the oesophagus during the examination. This makes it possible to evaluate the entire oesophagus from within. This type of endoscopy can be performed under sedation if desired, i.e. medications are given so that you sleep, so that patients do not have a conscious recollection of the examination. If any abnormalities of the mucosa are identified, small tissue samples (biopsies) can also be taken. These samples are then sent to a specialist laboratory to be examined under a microscope.

pH-metry

pH-metry is used to assess whether stomach acid is flowing back into the oesophagus, and if so, how often this occurs, and how long the acid remains there. For this examination, a small tube, only a few millimetres thick, is inserted via the nose into the oesophagus. A numbing agent can be applied to the throat and nose beforehand. At the tip of the tube there is a small probe which can measure the pH value in the oesophagus over a 24-hour period. The data is then transmitted to a storage device worn on the patient’s body for the duration of the examination.
pH-metry is usually carried out on an outpatient basis and therefore patient do not need to be admitted to hospital. During this 24-hour assessment, the patient can follow their normal daily routine with just minor restrictions to their activity.

Barium Swallow (X-ray)

A barium swallow assessment is a radiological investigation using a contrast medium (also known as a ‘swallow test’ or oesophagogram). For this investigation, the patient drinks small sips of a viscous flavoured liquid, which acts as the contrast medium. This liquid contains barium which makes it visible on X-ray imaging. It is then possible to follow the passage of food on the X-ray screen i.e. which path the contrast medium takes down the oesophagus and into the stomach. As the contrast medium is iodine-free, it can also be used in patients with iodine allergy or hyperthyroidism.

Manometry

Manometry is a specialist investigation used to measure pressure along the entire length of the oesophagus. The procedure lasts around 15 minutes and involves taking real-time measurements of the internal pressure of the oesophagus at various points along its length. With the patient in a seated position, a thin probe which is equipped with pressure sensors is inserted through the nose and down into the stomach. The patient is asked to swallow a small amount of water ten times consecutively, and recordings are made. The measured pressure values are then displayed in a colour graphic, giving a precise picture of what the swallow looks like. As a rule, the examination is well tolerated by patients and is not painful.

MRI / CT