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Hiatal Hernia

What is Hiatal Hernia?


Hiatal hernia is also known as hiatal hernia, diaphragmatic hernia, gastroesophageal reflux hernia. It is located at the level of the "pit of the stomach", inside and behind the lower region of the sternum. It is favored by overweight, sudden and intense efforts and some inappropriate eating habits.

The frequency of hiatal hernia in Mexico is 1-3% in adults and affects men twice as much as women, although this proportion has tended to equalize in recent years.

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What are the Symptoms of a Hiatal Hernia?


The symptoms of hiatal hernia are a consequence of the reflux of gastric contents into the esophagus and into the mouth, causing heartburn, burning in the “pit of the stomach”, nausea, persistent coughing and clearing, pharyngeal burning, earache, pain sensation of toothaches, bad breath, sudden and awkward nighttime shortness of breath with a choking sensation. These symptoms are accentuated by ingesting irritants, citrus fruits, fats, coffee, alcohol, smoking and having a large dinner. The patient with hiatal hernia prefers to sleep with more than two pillows at the bedside and frequently self-medicates ranitidine, omeprazole, antacid gel, or tries to ingest dairy products. It is common for all these symptoms to increase in direct relation to the accelerated and short-term increase in body weight.



How is a Hiatal Hernia Diagnosed?


The diagnosis of hiatal hernia requires the evaluation of a hernia specialist surgeon, a general surgeon or a gastro-surgeon who takes a complete medical history and is complemented by X-ray studies using an esophageal-gastro-duodenal series, endoscopy of the digestive tract. upper, also called panendoscopy, (that is, endoscopic view of the esophagus, stomach and duodenum), esophageal manometry (measurement of the pressures that exist within the esophagus) and, if considered necessary, PHmetry (measurement of the acidity of gastric juices and from inside the esophagus).

When a hiatal hernia associated with moderate or significant esophagitis is diagnosed, which also has insufficiency of the lower esophageal sphincter and a Phmetria with marked acidity is confirmed, the need to submit the patient to surgery is determined. Another reason that requires surgery is when the existence of the so-called “Barret's esophagus” is confirmed as a consequence of reflux. This term corresponds to the presence of cellular alterations in the layer that covers the esophagus, which have a high risk of becoming malignant over the years in most of these patients.


Hiatal Hernia Treatment


The treatment of hiatal hernia includes several facets:

a) Medications: Those that reduce the acidity of gastric juices, those that decrease gastroesophageal reflux and promote gastric emptying, those that neutralize the acidity of gastric juices, those that line the inner layers of the esophagus and stomach, exerting an effect protective quote. Since there are numerous medications on the market to treat the symptoms of hiatal hernia, it is pertinent that the hernia surgeon, gastro-surgeon or gastroenterologist determine the ideal regimen of these medications and avoid self-medication.

b) Diet: Restricting some irritating foods and drinks, reducing food intake during dinner, and going to bed after two hours, avoiding large meals and not eating between meals.

c) Habits: Stop smoking, avoid increased intra-abdominal pressure through belts, compression girdles, efforts, through exercises or postures, raise the level of the head of the bed when sleeping, lose weight.

d) Surgical treatment for hiatal hernia: It is the only resolution measure since through surgery, the anatomical alterations that exist in the hiatal hernia are corrected. There are several types of surgical procedures to operate the hiatal hernia, being laparoscopic fundoplication in its various modalities together with the closure of the hernia, the procedure that has demonstrated the best results worldwide because it is a minimally invasive surgery in which uses the highest technology and is practiced by the most prestigious surgeons in the world.

The decision to perform surgery for hiatal hernia requires detailed analysis by the hernia surgeon, gastro-surgeon, general surgeon or laparoscopic surgeon for each particular case as well as scrupulous preoperative preparation and detailed information about the procedure and its short and long term results.

Hiatal hernia surgery carries some risks such as: Probability of converting the procedure to open surgery, injury to the layers that surround the lung (pleura), injury to the esophagus itself and / or its nerves, the stomach, the liver, the spleen, postoperative disorders such as difficulty passing solid or bulky foods, burping or vomiting may also occur. From 20 to 30% of patients operated on for laparoscopic fundoplication lose weight in the following months after the operation. About 5% of those operated do not improve their symptoms of gastroesophageal reflux and require continuing with drug and dietary treatment; another 5 to 10% of them are not completely satisfied with the surgical results for many different reasons.

Recovery from hiatal hernia surgery includes one to three days of postoperative hospital stay, seven to twelve days of relative rest along with a special diet, and one to three months of medical surveillance with monthly appointments and the possibility of considering discharge upon discharge. end of this time. Some patients have had such a favorable evolution that they have been allowed to return to work a week after surgery, if their activities do not require intense efforts, however, most of them return to work within 15 days and can perform moderate exercises such as jogging, cycling, or swimming within 30 days of surgery.

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