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Diaphragmatic or hiatal hernia


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What is a diaphragm ? The diaphragm is the muscle separating the chest from the abdomen. Its main function is involved in breathing. The esophagus passes through an opening in the diaphragm (hiatus) and enters the abdomen to join with the stomach.

What isdiaphragmaticorhiatal hernia?

The innate or acquired weakness of this diaphragm and hiatal opening leads to its enlargement and gradual penetration of the stomach in the chest, 'because the abdominal pressure is greater than the pressure in the chest. This penetration is a diaphragmatic or hiatal hernia. The stomach is normally filled with food and air. If part of the stomach is in the chest cavity, it starts compressing the lung and the heart. Interference in these vital organs is caused. Diaphragmatic hernia distorts the work of the sphincter that prevents food and stomach fluids to go back into the esophagus. A reflux is created. Hydrochloric acid and digestive enzymes in the stomach damage the esophagus.  Infections, erosions or ulcers appear. Gastro-esophageal reflux disease (GERD) appears. With advancement of the disease narrowing and shortening of the esophagus or the so-called Barrett's esophagus occurs. This is a pretty advanced state and an operation would hardly help.

Whatare the symptoms ofdiaphragmatichernia?

The symptoms of the diaphragmatic hernia are chest pain, burning behind the breastbone, throwing up food in a supine position, palpitations and arrhythmia, pneumonia, anemia. The diagnosis is made by an X-ray, scanner and gastroscopy. Very often this disease is unreasonably treated with drugs  and the needed treatment is prolonged, while life passes in discomfort.

What isthe treatment ofhiatalordiaphragmatichernia?

Treatment with medications can reduce symptoms, but can not stop the growth of the opening and the movement of the stomach through the diaphragm hernia opening. An operation for diaphragmatic hernia is needed. It can be conventional – with an abdominal or chest incision, but much easier, less painful, with quicker recovery and good results is the laparoscopic (bloodless) operation. It is easier to reach the hernia opening. The stomach is taken back to the abdomen. The hernia sac is removed. The diaphragmatic opening is strengthened and the sphincter between the stomach and esophagus is recoverd. The result is a significantly quicker recovery than an opened abdominal or thoracic surgery.

If the hernia is left untreated, with time a great part of the stomach goes to the chest cavity. The lower two lines show a large oval difragmalna hernia.



An arrow on the top line on the X-rays shows a small diaphragmatic hernia. Large diaphragmatic hernias are shown on the bottom two lines.