What is Hiatus Hernia?
Herniation of any organ occurs when it pushes or migrates to an area outside of the walls of the cavity confining it.
Hiatus is an opening in the diaphragm, The muscular wall separating the abdomen from the chest cavity. Normally esophagus passes through the hiatus. If the stomach passes into chest then it is called hiatus hernia.
Hiatus hernia is of 3 types
Combination of both
Sypmtoms of Hiatus Hernia
Sliding hernia is the commonest of hiatus hernia and may present with heartburn. Though all heartburns may not have hiatus hernia
Paraosephageal hernia may give rise to decreased blood supply to stomach and lead to ischaemia of the stomach and its gangrene.
Complications of Hiatus Hernia?
It may remain asymptomatic or give rise to Reflux Esophagitis ie. acid refluxing into esophagus.
Rarely the stomach may suffer from ischemia and gangrene.
Diagnosis of Hiatus Hernia?
Barium swallow and meal can be used to diagnose hiatus hernia.
endoscopy is also used to diagnose the hernia In large Hiatus Hernia CT scan abdomen may be done to know the details of contents of the sac of hernia. PH metry should be performed to demonstrate reflux of stomach contents into esophagus.
PFT is done in patients with large Hernia and in patients with repeated chest infections due to reflux disease.
What is the treatment of Hiatus Hernia?
Hiatus Hernia is treated Laparoscopically. The reflux is prevented by creating an artificial valve by rolling the stomach around lower esophagus
In para esophageal hernia, the sac is dissected off its attachments and reflux is prevented by creating artificial valve in lower end of the esophagus by rolling stomach around it.
Cal-liberation of new hiatus and esophageal sphincter is mandatory.
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