A hernia of the esophageal opening of the diaphragm is the displacement of the stomach through the enlarged esophageal opening in the diaphragm into the chest cavity. There are 4 types of hiatal hernia.
Type 1: axial hernia of the esophageal opening of the diaphragm. This is the most common form (80-90% of all cases). Parts of the stomach are displaced along the axis of the esophagus and pass through the esophageal opening in the diaphragm into the chest. This is accompanied by symptoms such as heartburn, pain behind the sternum or in the upper abdomen, swallowing problems (dysphagia).
Type 2: paraesophageal hernia of the esophageal opening of the diaphragm. In this form, parts of the stomach protrude into the chest cavity next to the esophagus. Symptoms are similar to those of type 1.
Type 3: mixed form from type 1 and type 2.
Type 4: this type includes hiatal hernias with a large defect in the diaphragm, when other organs (for example, the spleen, parts of the small and large intestines) are displaced into the chest in addition to the stomach.
As a rule, gastroduodenoscopy is performed first. It is supplemented by the following diagnostic measures:
- X-ray of the stomach with a barium-containing contrast agent
- stomach acid measurement
- computed tomography (CT) or magnetic resonance imaging (MRI)
In cases where conservative therapy does not give the desired effect, resort to surgical treatment. Only surgery can eliminate the cause of the disease. The most common operating techniques are the Nissen and Rosetti fundoplication and the Toupet fundoplication.
Fundoplication according to Nissen and Rosetti: in this operation, a cuff is formed from parts of the stomach, which is applied around the lower part of the esophagus. Moreover, the anterior wall of the bottom of the stomach is placed behind the esophagus. The loop thus formed is sutured to the anterior wall of the stomach. Additionally, this cuff is fixed with sutures to the diaphragm.
Tupe fundoplication: the difference between this method and the previous one is that the cuff is not completely applied around the esophagus, and it is fixed with sutures, both to the diaphragm and to the anterior wall of the esophagus.
Another popular method of operation is gastropexy (other name fundopexy). With this technique of surgery, the stomach is displaced to its normal position and sutured to the anterior abdominal wall.
At chiatoplasty (plastic hernia of the esophageal opening of the diaphragm) the hernial orifice is sutured.
Unfortunately, after these operations, with varying degrees of probability, a complication arises: swallowing disorders.
A new hernia treatment hiatal opening of the diaphragm
In the clinic of Dr. Tsarras, a new surgical technique developed by him is used - functional reconstructive plasty of the lower esophageal sphincter. It completely eliminates the occurrence of such complications. In this minimally invasive operation, the esophagus is first freed of adhesions to the diaphragm in order to bring the lower esophageal sphincter into the abdominal cavity without tension. Then, with 3-4 sutures, the hernial orifice formed in the diaphragm as a result of the disease is sutured. To prevent recurrence, a synthetic mesh is additionally installed in this place. In conclusion, the esophagus is fixed with several sutures to the dome of the stomach. This operation does not require the formation of a cuff.
Thus, as a result of the operation, there is an effective restoration of the locking mechanism that prevents the reflux (reflux) of gastric juice into the esophagus.
Head of the Clinic for General, Visceral and Minimally Invasive Surgery
Head of the Clinic for General, Visceral, Thoracic and Endocrine Surgery
Head of the Clinic for General and Visceral Surgery