Nissen Repair - Hernia

[Loni1234]

I had a chronic cough for over 10 yrs and Dr's were unable to explain why.  I would cough so hard that I would vomit.  I also had the worst heartburn which was unbearable at times.  I had tried all the usual heartburn meds and was not able to get any releif.  The Dr's found a nodgule in my neck and thought that may be contributing to my chronic cough so we decided to have my Thyroid radiated but that did not solve the problem, it only created a new one.  I am now Thyroid dependent.

In 2004 I had a Nissen done which resolved my heartburn issue and I no longer had to take any heartburn meds.  I did however have a lot of trouble with stomach pain and bloating with every meal I ate.  Over a period of 6 months I lost over 45 lbs.  In 2005 I had the Nissen stretched and was finally able to get some relief and life was good.  

I also suffer from migraine headaches and with migraines comes the gut wrenching dry heaves.  Over the yrs the heartburn has come back so I am back on heartburn meds and once again not getting much relief.  I was scoped a few yrs ago and they said the Nissen was only partially in tact most likely torn from vomiting with the migraines.  They also could see a hiatal hernia but said it was nothing to worry about.    

Now 2010 my cough is back and the heartburn just as sever as before.  I had another scope done last week and the Dr said the Nissen looks the same but there is what appears to be a paraesophagial hernia.  I have been scheduled to have a Barium Swallow tomorrow and then another Manometry test as well (which I swore I would never let them do to me again).  I've had this test done to me 4 times now and as you know it is very painful.  

My question is what is the difference between a hiatal hernia and a paraesophagial hernia?  Do they grow in size and if so could that explain why my cough is back now since they were aware that I had some kind of hernia as shown on my previous scope.  If they were to go in and fix the hernia and the Nissen, am I likely to have the same kinds of issues that I experienced with my previous Nissen surgery?  Would I be starting all over again?  Also what can I do to prevent the tearing when I get the dry heaves from these migraines?          

[Loni1234]

Thanks CalGal,

The link is a great picture showing the difference between the two, thank you.  They have referred me to see a surgeon but not until after the PH study is done.  She didn't say if the surgeon was a throat Dr. or GI.  I just hope they get the ball rolling soon this coughing is driving me nuts.  My chest feels like I've been hit by a freight train.

[CalGal]

THis link is a little technical, but it shows pics of the difference between a hiatal hernia and a paraesophageal hernia: http://www.nature.com/gimo/contents/pt1/fig_tab/gimo48_F7.html

Paraesophageal hernia can grow, and they're more problematic than a hiatal hernia in general. One of the reasons you may be having issues with coughing is the 'tight seal' of the thoracic cavity is compromised with a paraesophageal hernia. It means the pressure within that side of the chest isn't being maintained properly. In many cases a GI doc wouldn't be the one to do the surgery on this form of hernia, although I could be incorrect on that. From what I know correcting a paraesophageal hernia is something that is handled by a thoracic surgeon, but please check with your doc on that portion of your question.