Symptoms and treatment of esophageal hernia .Surgery for hernia

Category Hernias | August 12, 2017 18:01


  • Causes esophageal hernia hernia symptoms
  • Complications of the disease
  • Diagnosis and treatment

Under esophageal hernia refers to the protrusion of the lower esophagus through the hole in the diaphragm.In the literature you can find another pathology name - diaphragmatic hernia.

esophageal hernia can be congenital or acquired, with congenital hernia of the esophagus is a rare pathology, in which the marked shortening of the length of the esophageal tube.

Causes esophageal hernia

The main reasons for hernia of the esophagus should include:

  • pregnancy (during this period the fetus has an additional effect on the internal organs, causing their displacement);
  • resorption of fat tissue under the diaphragm (that adipose tissue maintains the esophagus in a normal position);
  • atrophy of the liver (especially the left lobe);
  • change the position of the internal organs;
  • increased abdominal department (sharp abdominal muscle strain or strong flatulence);
  • operations on the esophagus;
  • reduction esophagus (as a result of a thermal burn);
  • dyskinesia of the esophagus;
  • congenital short esophagus (the share of this cause only 0.3% of all reported cases of esophageal hernia);
  • weakening of the muscles and ligaments that support the esophageal opening of the diaphragm and esophagus.

should be attributed to risk factors:

  • unhealthy lifestyle;
  • chronic constipation;
  • excessive overeating;
  • digestive problems;
  • overweight.

should be noted that in most cases, this pathology is registered in people older than 50 years, because in this age marked loss of muscle elasticity.Thus, by the age of 60 esophageal opening in some patients increased to such an extent that it can skip two, and sometimes three, finger, thereby forming a hernial ring.

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hernia symptoms

Symptoms of esophageal hernia manifests itself as the disease progresses.Main symptoms:

  • often there is pain behind the breastbone or chest (triggered by food intake, change in body position, leaning forward, subsides after vomiting and regurgitation);
  • frequent heartburn (not related to food intake);
  • shortness of breath and lack of air;
  • belching;
  • palpitations (a symptom is observed mainly at night);
  • heartache (occurs while taking the horizontal position of the body);
  • regurgitation (casting of gastric contents into the mouth);
  • dysphagia (the phenomenon is periodic);
  • difficulty passing food through the esophagus;
  • sensation of fullness in the epigastric region (occurs after a meal).

should be noted that many patients with esophageal hernia manages to reveal a stomach ulcer or duodenal ulcer, pancreatitis, cholecystitis and chronic gastroduodenitis.For this reason, if a person has these diseases it is mandatory to check for esophageal hernia, to early treatment.

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Complications of the disease In the absence of adequate and timely treatment of hernia of the esophagus leads to:

  • erosions and ulcers of the stomach;
  • bleeding;
  • esophageal cancer;
  • anemia;
  • cicatricial narrowing of the esophagus;
  • esophageal shortening.
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Diagnosis and treatment Diagnosis

esophageal hernia is based on carrying out a gastroscopy and X-ray study of the body.In addition, a mandatory appointed:

  • ECG (in order to remove the diagnosis of heart disease);
  • blood test;
  • fluoroscopy or chest x-ray (for the purpose of removing the lung pathology diagnosis).

hernia, not showing herself or small size, specific treatment is not expected to be only a strictly observe the rules of supply:

  • exception of a diet of hot food;
  • avoid overeating and eating at night.

also required:

  • avoid obesity and carefully monitor their weight;
  • held annually (2 times) a medical examination;
  • refuse smoking and alcohol;
  • to eat (it is desirable not to use products that trigger the production of hydrochloric acid and gastric juice);
  • get rid of other diseases of the gastrointestinal tract, if any;
  • avoid excessive physical exertion and strong.

the presence of symptoms pass conservative treatments, including drugs intended to help reduce the production of gastric juice, thus reducing the acidity.It should be noted that the ingress of gastric juice into the esophagus is extremely undesirable since it causes inflammation of the body, which may lead to the development of esophageal strictures or cancer.As major used drugs act:

  • prokinetics (contribute to the normalization of bodies of motor activity);
  • proton pump inhibitors (blocking the production of hydrochloric acid, thereby reducing the acidity of gastric juice);
  • antacids (reduce the acidity of gastric juice).

Such therapy is scheduled for elimination of the main symptoms of the disease and does not involve inhibition of the progression of the disease.For this reason, after a certain time, patients undergo operative treatment methods.They are conducted in cases where:

  • education reaches a considerable size;
  • patient complains of frequent heartburn;
  • patients have problems with digestion and swallowing disorders;
  • dysplasia observed esophageal mucosa (as a result of frequent starts casting stomach contents reconstructed organ mucosa, leading to cancer);
  • hernia was the cause of esophageal ulcers, esophagitis or erosion.

main goal pursued by the operation is to prevent stomach contents entering the esophagus, which can be achieved in several ways. today for the treatment of esophageal hernia is used in most cases, Nissen fundoplication, which can be done either laparoscopically or open.It should be noted that by the laparoscopic method is not resorted after repeated esophageal hernia.

Meanwhile, operations are divided into the following groups:

  • with herniorrhaphy, as well as to the strengthening of the esophageal-diaphragmatic ligament (this krurorafiya and plastic diaphragmatic hernia);
  • with fixation of the stomach (this gastropexy);
  • esophageal resection (when scar stenosis not amenable to conservative treatment);
  • with the restoration of the acute angle between the esophagus, abdominal his department, and the bottom of the stomach (this fundoplication).

prognosis after surgical treatment of esophageal hernia favorable.