Laparoscopic Hiatal Hernia Repair

LEARN MORE ABOUT HIATAL HERNIA

The diaphragm is the muscle that separates the thorax from the abdomen. The diaphragmatic hiatus is part of the anatomical barrier that separates the esophagus from the stomach.

If the stomach moves to the thorax, this barrier is not effective and the gastric content can easily pass into the esophagus. Therefore, the existence of a hiatus hernia favors gastro-oesophageal reflux, but it is not the only cause.

Although it is more frequent after the age of 50, there are many people of all ages, otherwise healthy, who have a hiatus hernia.

What are the symptoms?

Burning (“heartburn” in medical terms) that ascends from the stomach to the throat is the main symptom of GOR. It is possible that it is associated with the passage of acidic or bitter foods from the stomach to the mouth.

It usually worsens after meals, especially with foods that promote sphincter relaxation or dietary excess. In many cases, it also gets worse during the night’s rest or when the trunk is flexed.

In some cases the predominant symptoms are respiratory: aphonia or rashes (due to irritation of the larynx by acid reflux or even asthma or respiratory distress (by aspiration of the acid into the respiratory tract).

What are the causes?

Hiatus hernia occurs when the upper portion of the stomach ascends to the thorax through a small opening that exists in the diaphragm (diaphragmatic hiatus). The diaphragm is the muscle that separates the thorax from the abdomen.

The diaphragmatic hiatus is part of the anatomical barrier that separates the esophagus from the stomach. If the stomach moves to the thorax, this barrier is not effective and the gastric content can easily pass into the esophagus. Therefore, the existence of a hiatus hernia favors gastro-oesophageal reflux, but it is not the only cause.

The need to treat a hiatus hernia depends on the existence of two possible associated complications:

  1. Existence of severe gastro-oesophageal reflux.
  2. Strangulation of a hernia.

That is, the existence of a hiatus hernia “per se” does not require treatment unless there are the aforementioned complications.

There are dietary factors or forms of life that can contribute to gastro-esophageal reflux.

Chocolate, pepper or spices, mint, fats, coffee and alcoholic beverages favor the relaxation of the LES and, therefore, reflux. Tobacco also produces sphincter relaxation.

All those situations that suppose an increase of the intra-abdominal pressure (obesity, pregnancy, certain types of physical exercise) also favor the GER.

Who can suffer it?

Although it is more frequent after the age of 50, there are many people of all ages, otherwise healthy, who have a hiatus hernia.

More than 40 percent of the general population has ever had heartburn or heartburn at least once a month and about 7 percent have it on a daily basis.

What is your prognosis?

There are several complications derived from GER, although these do not occur in most cases. They depend on the severity of the reflux in each subject.

The most frequent is esophagitis, which is the inflammation of the esophageal mucosa that is exposed to acid. There are different degrees. Severe esophagitis can: ulcerate and bleed; Heal irregularly, reducing the diameter of the esophageal lumen and hindering the passage of food.

In some cases, a change of the normal esophageal mucosa may occur, which is replaced by a mucosa more similar to that of the stomach or the small intestine, more resistant to acid. This situation is known as “Barrett’s esophagus” and its main importance is that it is considered a risk factor for developing esophageal cancer.

DIAGNOSIS AND TREATMENT OF HIATUS HERNIA IN THE CLINIC

The initial diagnosis of a hiatus hernia is based on the symptoms; However, if these are daily or it is necessary to maintain pharmacological treatment for more than 2-3 weeks, it is convenient to perform explorations aimed at knowing:

  1. The existence or not of gastroesophageal reflux (GER).
  2. The existence or not of complications derived from GER.
  3. Discard other lesions that clinically resemble GER and have a different treatment and prognosis.

The diagnosis will be made using endoscopic techniques, and it may be necessary on occasion to perform a ph-metry to determine the degree of acidity existing in the esophagus.

The treatment will go from postural measures and habits of life, drugs for a more or less prolonged time; When these measures fail and in very studied cases, treatment by fundoplication may be indicated.