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Hernia of the esophageal opening of the diaphragm

In our Medical Center, laparoscopic treatment of hiatal hernia is performed.

Hernia of the esophageal opening of the diaphragm (HH) – a protrusion of the stomach towards the chest.

The main symptoms of a hernia of the esophagus:

– heartburn;
– chest pain;
– bad breath;
– sour belching.

Normally, the esophagus flows into the stomach at an acute angle (Giss angle), and a fold is formed from the mucous membrane (Gubarev’s valve). These two conditions prevent the return of food and digestive juices (hydrochloric acid, bile, enzymes) into the esophagus.

The degree of hiatal hernia:

– I degree – in the chest cavity (above the diaphragm) is the abdominal esophagus, and the cardia – at the level of the diaphragm, the stomach is raised and directly adjacent to the diaphragm.
– II degree – in the chest cavity is the abdominal esophagus, and directly in the esophageal opening of the diaphragm – already a part of the stomach;
– III degree – above the diaphragm are the abdominal esophagus, cardia and part of the stomach (fundus and body, and in severe cases even the antrum).

Treatment of hiatal hernia:

Operative treatment

restoration of normal anatomy and elimination of the hernial opening.

The operation has two goals:

1) reducing the size of the esophageal opening of the diaphragm, to prevent the displacement of the stomach into the chest;

2) fundoplication – the formation of a cuff from the stomach around the esophagus (“non-spill effect”), which 100% prevents the reflux of the contents of the stomach into the esophagus.

Conservative (symptomatic)

elimination of the symptoms of the disease, without solving the problem as a whole.

Improves the quality of life. However, it does not prevent the occurrence of a number of complications.

The diagnosis can be established based on the data of the following studies:

X-ray of the stomach with contrast
CT scan

The essence of the hiatal hernia disease is an increase in the size of the esophageal opening of the diaphragm, due to a congenital predisposition, as well as under the influence of pressure from the abdominal cavity (it is higher than in the normal thorax). In this case, the area of ​​the esophagus near the stomach and the stomach itself begins to move towards the chest. This leads to a change in the anatomy and relationship of the esophagus and stomach. In this case, the angle of Giss becomes obtuse, and the Gubarev valve disappears altogether, which leads to the reflux of the contents of the stomach into the esophagus. As a result, characteristic symptoms arise.

Complications of a hiatal hernia:

– esophagitis
– erosion and ulceration of the esophagus
– esophageal stricture (narrowing of the lumen due to chronic inflammation)
– infringement of a hernia of the esophageal opening of the diaphragm
– intestinal meteplasia of the epithelium of the esophagus (Barrett’s esophagus)
– esophageal carcinoma

Esophagitis, erosion and ulcers of the esophagus are different stages in the development of one process. Hydrochloric acid, getting on the mucous membrane of the esophagus, causes a chemical burn. With repeated episodes, inflammation penetrates into deeper layers, and the epithelium sloughs off. Periodic inflammation of the esophagus leads to damage to the muscle layer, which in turn reduces elasticity and impairs the passage of solid and, over time, liquid food.

Infringement of a hiatal hernia – like all hernias, this pathology is prone to infringement. In this case, a characteristic symptom is pain behind the sternum or in the upper abdomen. But the infringement of this area has its own characteristic features. Due to the fact that the diaphragm is a weak muscle (in comparison with the muscles of the press), and the wall of the stomach is rather thick, the infringement does not lead to necrosis of the stomach. The process becomes chronic, and a trophic stomach ulcer appears at the place of infringement (due to squeezing, the blood supply to the restrained area is disrupted, and under the influence of an aggressive environment, the stomach wall ulcerates).

This ulcer has typical symptoms, but does not lend itself to classical conservative treatment, since the mechanism of occurrence is radically different.

Therefore, it is possible to cure such an ulcer only after the elimination of the infringement !!!

Intestinal metaplasia of the esophageal mucosa (Barrett’s esophagus) is caused by exposure to bile and duodenal contents. With frequent ingress of bile into the esophagus, an adaptive mechanism is triggered, the purpose of which is to replace the epithelium with a more suitable one for the newly formed environment. In this case, the process of transformation of the epithelium can “turn in the wrong place” and begin to grow continuously. In this case, esophageal cancer occurs.


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