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Diaphragmatic hernia

hernienzentrum Dr.Med.Enrico Pöschmann
hernienzentrum 8-Dec. 2022

Difficulty swallowing and heartburn can indicate a hiatal hernia. How this is treated is best decided by a gastrointestinal specialist and a skilled surgeon working as a team.

Symptoms of a diaphragmatic hernia

Do you suffer from acid regurgitation, shortness of breath after eating or an unclear feeling of pressure in the abdominal area? This could be caused by a hiatal hernia or diaphragmatic hernia. This is often accompanied by difficulty swallowing, which often occurs with dry foods such as bread or meat. The patient has to drink more while eating to be able to swallow the food properly. The saliva may become foamy or viscous and the food may come back up. In the worst case, there is pain in the chest area that can radiate to the back.

What exactly happens in a diaphragmatic hernia?

The diaphragm has the function of a partition between the chest and the abdominal cavity. The oesophagus transports our food into the stomach and runs vertically through the diaphragm. The opening in the diaphragm is enlarged in a hiatal hernia, so that parts of the stomach can temporarily or even permanently push through the gap towards the chest. The most serious case is the so-called upside-down stomach, in which the entire stomach moves from the abdomen to the chest.

Causes of a diaphragmatic hernia

The cause of a hiatal hernia or diaphragmatic hernia can be a chronic connective tissue weakness or weight fluctuations, especially strong weight gain. Chronic connective tissue diseases such as rheumatism, chronic coughing or pregnancy can also trigger a hiatal hernia. Diaphragmatic hernias occur more frequently in old age. However, they can also occur in young patients. It is usually a gastrointestinal specialist who makes the diagnosis during a gastroscopy. He or she can examine the hernia with a camera and assess whether the acid running back from the stomach into the oesophagus has led to a chronic change. If this is left untreated, in the very worst case it can lead to a change in the cells of the oesophagus and to cancer over many years.

Consultation with a surgeon

The exact size of the hernia cannot usually be reliably assessed by the gastrointestinal specialist, so that a computer tomography with a so-called Valsalva manoeuvre is often still required as part of a corresponding examination at the surgeon's in order to plan the further procedure. For this, the patient is X-rayed in a narrow tube and has to close the nose and mouth during the examination and press massively. This simulates the overpressure in the abdomen and allows the surgeon to see the exact extent of the hernia. Depending on the symptoms and the size of the hernia, an attempt is first made to remedy the discomfort caused by the acid receding from the stomach with medication. The acid production is blocked by medication, whereupon the irritation of the mucous membrane recedes. If this is of too little use because intolerable side effects occur or the symptoms worsen, a surgical solution must be considered.

Surgical treatment of a diaphragmatic hernia

An operation aims to close the oversized gap in the diaphragm. This is usually done minimally invasively by means of laparoscopic surgery (laparoscopy) or with the help of a surgical robot. The parts of the stomach that have slipped into the chest are moved back into the abdominal cavity and the gap in the diaphragm is closed using various techniques. It is preferable to aim for a biological closure, where the muscle loops in the diaphragm are reunited to achieve natural stability. If necessary, this situation can also be temporarily secured with a dissolvable plastic net, which does not cause any permanent problems. Sometimes it is also necessary to form a sleeve from the stomach itself, which is placed around the stomach to prevent it from receding into the chest.

Possible complications

There are different surgical methods, all of which have their advantages and disadvantages. After the operation, you can expect a slight swelling in this area and slight disturbances in eating, but these should subside quickly. In the best case, all the symptoms of discomfort from before the operation are quickly resolved. However, especially in the case of large fractures and necessary operations with a cuff technique, there are also recurrences. This means that a fracture can occur again, which may have to be operated on again. It is also possible that the constriction is too severe, so that there are permanent disturbances in the intake of food and swallowing difficulties, which also have to be corrected again by an operation. In this respect, a surgical intervention must be carefully weighed up. A good consultation with an experienced surgeon in consultation with a gastrointestinal specialist is of great importance. The advantages and disadvantages should be discussed in detail with the patient. Do you have complaints that indicate a hiatal hernia? Make an appointment for a consultation at the Hernia Centre Switzerland.

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