What is a hiatal hernia?

A hiatal hernia differs from other abdominal hernias in that it occurs inside the abdomen. More specifically, a hiatal hernia occurs when a gap/gap is created in the diaphragm, the muscle that separates the chest cavity from the abdominal cavity, which allows the intra-abdominal viscera (stomach, intestine, liver) to move into the chest cavity, causing a series of from symptoms and complications for the sufferer.

What causes the appearance of a hiatal hernia?

Hiatal hernias can be congenital or acquired. Relatives are those that are present from birth and are due to some anatomical dysfunction/abnormality.

Acquired ones can occur after an injury that leads to a ruptured diaphragm, after some other surgical operation, or more commonly due to certain factors related, for the most part, to the lifestyle and habits of the patient.

The main risk factors for creating hiatal hernia are chronic cough, weight lifting, obesity, constipation, pregnancy, which can lead to chronically increased intra-abdominal pressure.

What are the symptoms of a hiatal hernia?

Hiatal hernia symptoms can vary depending on the size and severity of the hernia. Small hiatal hernias may be asymptomatic and discovered as an incidental finding on gastroscopy. Depending on the morphology of the hiatal hernia, four categories are distinguished. Noteworthy is the fact that hiatal hernia is a major cause of gastroesophageal reflux, with the result that these two conditions are often confused.

Typical symptoms of a hiatal hernia are:

• Indigestion
• Posterior sternal pain/burning (burning sensation)
• Bloating
• Burping (burping)
• Heartburn
• Bitter and/or sour taste due to reductions

How is a hiatal hernia diagnosed?

The diagnosis of hiatal hernia can be achieved by taking the patient’s medical history and physical examination in conjunction with the study of imaging tests (CT scan of the chest and upper abdomen, ultrasound of the upper abdomen).

For the best diagnosis and the design of the appropriate treatment plan, it is considered necessary to perform a gastroscopy, manometry and pH measurement of the esophagus, passage (x-ray) of the esophagus with barium, radiological control with contrast and the study of gastric emptying, as directed by the surgeon.

How is hiatal hernia treated?

At an early stage, hiatal hernia can be treated conservatively with the aim of limiting symptoms. Depending on the case, medication with prazoles is given and it is recommended to avoid lying down immediately after meals and to adopt a balanced diet, low in fat, with the consumption of small and frequent meals, as well as the inclusion of physical activity in the patient’s daily routine. Losing excess weight has beneficial effects on symptom control by reducing intra-abdominal pressure.

In patients where the problem does not subside with the application of conservative treatment, and any esophagitis persists, the symptoms recur, as well as in cases where it is deemed necessary from the outset, surgical treatment with minimally invasive methods is recommended. Laparoscopic and robotic surgery allow, with small holes of 5-10 mm, the treatment of hiatal hernia with the advantage of minimal post-operative pain, reduced blood loss and a faster return of the patient to normal activity.

The aim of surgery is to return the intra-abdominal viscera above the diaphragm to their normal position, to restore the gap in the diaphragm with or without mesh placement and finally to restore the normal anti-reflux mechanism to eliminate the reflux of acid contents into the esophagus with blurring. Tumorplasty is the folding of the dome, which is part of the stomach, around the lower part of the esophagus and strengthens the function of the lower esophageal sphincter. Patients with coexisting morbid obesity (BMI>35kg/m2 according to the 2022 IFSO guidelines) benefit more from the combination of hiatal hernia gap repair with bariatric surgery (eg gastric bypass).

in conclusion

Diaphragmatic hernia, once diagnosed, can be effectively treated initially conservatively with lifestyle modification and, upon failure or indications during the initial diagnosis, surgically with minimally invasive methods with excellent results.

Surgical reconstruction, laparoscopic or robotic, requires appropriate surgical education and training by a specialized team. HYGEIA and specifically the First Surgical Clinic has been distinguished and certified as a center of excellence for such surgeries.