Whether the sliding hernia grows under. Features of the treatment of sliding hernia of the esophagus. What hardware and laboratory studies show

Sliding hernia is characterized by the absence of a hernial sac, it can be congenital or acquired, and in the early stages of formation it has a poor symptomatic picture and is diagnosed only with instrumental examination. With this pathology, a part of the stomach protrudes beyond the diaphragm, and the organ, thus, acts as a hernial sac. Allocate fixed and non-fixed hernia of the esophagus, which is differentiated from a congenital or acquired defect - a short esophagus. Traction hernias, which occur against the background of contraction of the esophagus, and pulsion hernias, which form against the background of weakness of muscle tissue, are classified separately.

At the heart of the disease, a sliding hernia of the esophageal opening of the diaphragm is the weakness of the muscular wall, which passes through itself part of the stomach outside the diaphragm. Such a deviation is typical during the period of a decrease in the protective mechanism: pregnancy, progressive obesity, when intrauterine pressure rises significantly and the organ becomes higher than the diaphragm. It is worth highlighting sliding hernias, provoked by weakness of the esophageal sphincter, as well as a disease of adjacent tissues that develops even in the prenatal period.

Etiology of a sliding hernia

Diaphragmatic hernia or hiatal protrusion differs from other forms of the disease in its localization. A wandering hernia implies the location of a part of the stomach above the diaphragm, and thus the organ independently forms a hernial sac. A fixed protrusion is characterized by a stable position of the affected organ, regardless of the position of the patient's body or jumps in intrauterine pressure. An unfixed protrusion is otherwise called a wandering hernia, since its localization can change.

The difference in pressure between the abdominal and thoracic cavities leads to the backflow of the contents of the stomach back into the esophagus, which ends with serious consequences for it: the development of erosion, ulcerative lesions of the esophagus, while the patient feels discomfort, often the disease is accompanied by severe pain. Chronic reflux leads to severe inflammation of the esophagus, it becomes irritated and bleeds, which can result in an anemic syndrome.

The following negative factors can trigger the formation of hiatal pathology:

1. Weakness of the muscular wall that holds the stomach in its anatomical place.
2. Depletion of ligaments with increased stress on the body can weaken the muscle barrier.
3. The period of pregnancy, when intrauterine pressure increases, and the diaphragmatic opening increases.

With an unfixed hiatal protrusion, the stomach changes its position and returns to its place when the position of the patient's body changes, but this does not reduce the protrusion and requires adequate treatment. A hernia of the esophagus can have different sizes, with a long course of the pathological process, a large hernial protrusion is observed. The consequence of a sliding or wandering hernia is the fixation of the stomach above the diaphragm and the formation of scars along the edges of the hernial sac. Against this background, a shortening of the esophagus develops, and a fixed protrusion will be constantly outside the diaphragm.

Important! With a wandering hernia, pinching is impossible, because the blood circulation is preserved and the hernial lesion does not appear for a long time, but instead stenosis or reflux esophagitis may develop.

Clinical manifestations of a sliding hernia

The appearance of the first specific symptoms is observed with the appearance of concomitant deviations of the esophagus and stomach, as well as in case of complications.

Complaints of patients with a sliding hernia of the diaphragmatic opening:

• soreness in the stomach area is due to the appearance of an inflammatory process and reflux;
• increased salivation, against which dental diseases may appear;
• burning sensation in the chest area;
• frequent heartburn, belching, regurgitation;
• sensation of a foreign body in the throat;
• increased blood pressure, difficulty breathing.

Clinical manifestations of hiatal lesions may differ in each patient, depending on the position of the body and associated pathologies of the digestive system. A mandatory symptom of the disease for all patients is a burning sensation behind the sternum. The nature of pain in hiatal hernia has its own pattern, a painful attack occurs after saturation and filling of the stomach, and depends on the amount of food. Increased pain and discomfort occurs with an increase in physical activity on the body, with overeating, the presence of congenital or acquired pathologies of the cardiovascular system.

Important! The pain of a hiatal hernia is easily relieved by drugs to treat high stomach acid.

Techniques for the treatment of a sliding hernia

Sliding hernia of the esophagus without complications can be treated with medications. Antacids, antispasmodics, painkillers are prescribed.

1. Antacids (Gastal, Phosphalugel) are prescribed for increased acidity of the stomach to normalize the pH and relieve the painful syndrome.
2. The drug De-nol is indicated to enhance the protective function of the mucous membrane of the digestive system.
3. Antispasmodics are aimed at treating spasm and pain relief.
4. The drug Motilium is prescribed for the symptomatic treatment of belching, regurgitation, heartburn.

Comprehensive treatment of a hiatal defect requires a change in nutrition, the patient is prescribed a special diet.

1. Eating chopped foods in small portions, but often.
2. Heavy fatty, fried, pickled foods are excluded.
3. The diet consists of steamed dishes: vegetables, cereals, white meat.
4. The last meal occurs an hour before bedtime.

An obligatory stage in the treatment of a sliding hernia is the normalization of the daily regimen, the reduction of physical and emotional stress, and the exclusion of smoking. It is important to do gymnastics regularly, and for this there are special exercises shown to patients with a sliding hernia. Hiatal protrusion can be complicated and progress, therefore, in order to prevent bleeding, stenosis, scarring, the doctor may prescribe surgical treatment aimed at restoring the anatomical position of the stomach and excising the tissues affected by the ulcer.

With age, the septum of muscles loses its elasticity and flexibility. The esophagus protrudes into the sternum through a hole in the diaphragm. alimentary esophageal opening of the diaphragm most often occurs in adulthood.

A hernia of the esophagus most often occurs in adulthood.

Depending on the location of the defect, there are:

• axial hernia;
• cardiac rupture.

There are several types of pathology:

• shortened (detected in people with a birth defect);
• paraesophageal hernia;
• sliding hernia.

A feature of a sliding hernia is the difficulty of diagnosis. The reason is that the symptoms of this disease are quite mild. Falling out itself can only be determined under certain conditions.

A distinctive feature of this defect is that the displacement into the sternum occurs along the axis of the esophagus. The location of the hernia affects the position of the top. In this case, the falling out leads to the fact that the upper part of the patient's stomach is above the level of the diaphragm.

The stomach takes part in the formation of a hernial formation. There are 2 types of sliding hernia: fixed and non-fixed. The position of the patient does not affect the location of the hernial sac. If a person assumes a vertical position, then a fixed hernia will remain in the sternum. The formation is held by adhesions that form in the area of ​​the hernia.

Specialists distinguish between sliding hernias with congenital and acquired defects. There is a difference in pressure between the sternum and. Due to this difference, the contents of the stomach enter the esophagus.

The mucous membrane of the esophagus is quite sensitive to such substances. This causes the appearance of erosions and ulcers. The patient experiences inconvenience, discomfort and severe pain. The inflammatory process in the esophagus develops gradually. In this case, the mucous membrane bleeds and is constantly injured.

The patient begins anemia associated with iron deficiency due to tissue manifestation.

What is a hiatal hernia, the video will tell:

Reasons for the formation of a sliding hernia

Increased salivation is a sign of a sliding hernia.

The condition of the ligaments affects the formation of the esophageal opening of the diaphragm.

The upper part of the stomach with this disease is shifted upward. This leads to the fact that the muscle ligament becomes much thinner.

The stretching of the ligament provokes an increase in the diameter of the esophageal opening. The patient develops a complication with regular overeating. If such a defect is detected, the doctors refer the patient for surgery.

There are several methods for removing hernias. Thanks to the fundoplication around the esophagus, the surgeon creates a special cuff. It prevents reflux of stomach contents into the esophagus. During the operation, a laparoscopic method is used. With its help, doctors manage to reduce trauma to a minimum. This shortens the length of the patient's recovery period.

However, the possibility of slippage of the cuff cannot be ruled out. This increases the risk of complications after surgery. Surgical intervention in most cases helps to achieve positive results. Success largely depends on the passage of physiotherapy procedures during rehabilitation.

Sometimes hernial prolapse is fixed in one position. This is due to the narrowing of the scars in the hernial sac. In this case, the patient is diagnosed with an acquired shortening of the esophagus. The esophageal canal is located above the diaphragm.

In severe cases, a person may develop fibrous stenosis. A complication of a sliding hernia is also reflux esophagitis. The sliding fallout cannot be impaired. If there is a narrowing of the hole, then the cardia is compressed, which enters the sternum. This condition does not lead to circulatory disorders.

What are the signs of the disease

Heartburn is a symptom of a sliding hernia.

Sliding hernia of the esophagus does not have clear manifestations. Symptoms in a patient appear only when various complications of the disease occur.

There are several characteristic signs of a sliding hernia of the esophagus:

1. the patient begins to complain about;
2. he suffers from bouts of belching;
3. there is pain in the esophagus;
4. regurgitation occurs after eating;
5. people experience a burning sensation behind the sternum;
6. a lump appears in the throat;
7. there is an increased secretion of saliva;
8. some patients have high blood pressure.

Symptoms of the disease depend on the position of the patient's body. Burning occurs in almost every person with this pathology. Severe pain is experienced by a person with a stomach ulcer. A large amount of food can provoke the appearance in the esophagus.

By taking acid-reducing agents, you can get rid of discomfort.

How is the diagnosis carried out

To identify a sliding formation, experts use several methods:

1. in the process of gastroscopy, doctors use endoscopic equipment to determine inflamed areas, the presence of ulcers and erosions;
2. fluoroscopy of the stomach is designed to assess the state of hernial formations;
3. a study of changes in daily pH in the esophagus is designed to determine which leads to the appearance of pain.

Features of treatment

Maalox will help reduce the acidity of the esophagus.

To eliminate the defect, doctors use traditional methods. The complex of therapeutic measures includes a special diet, therapeutic exercises, medication.

To reduce acidity, doctors prescribe antacids to patients (Phosphalugel,). To help patients suffering from attacks of belching, you can use Motilium. The dosage is indicated by the doctor, taking into account the patient's condition.

However, with serious complications, these methods do not allow to achieve positive results. In this case, the patient is sent for surgery.

Sometimes patients experience slippage of the cuff, and the disease occurs again. Reoperation can help such patients.

Patients must adhere to At the time of illness, you will have to abandon the use of fatty and spicy foods. Eliminate smoked meats and marinades from the diet. Eat small meals to speed up the digestion process.

After the operation, patients should not engage in intensive physical labor. It is forbidden to do exercises that provoke an increase in pressure in the abdominal cavity.

Telegram

Along with this article read:

• 
  
• 
  Classification, treatment and symptoms of hernia of the esophagus. Details about…

The esophagus is a connecting tube between the pharynx and the stomach that passes through an opening in the diaphragm. Disturbances in the gastrointestinal tract provoke diseases of the esophagus. These include such gastroesophageal reflux disease as a sliding axial hernia of the esophageal opening of the diaphragm (HH).

Feature of the pathology

During the development of the disease, the cardial part of the stomach moves to the sternum through the diaphragmatic opening. There are several types of hiatal hernias:

• paraesophageal (this type is characterized by the fact that the increase and growth of part of the stomach occurs on the left side of the esophagus);
• axial (its main difference is the absence of a hernial sac, which allows it to penetrate into the chest cavity and return freely). May be fixed or non-fixed;
• combined (in this case, both types of hernia develop - axial and paraesophageal).

What is a hiatal hernia (video)

Classification of HH according to the severity of the disease

Causes of axial hernia

Hernia formation can be influenced by both congenital and acquired factors.

Symptoms and signs

At the beginning of the development of the disease, the symptoms almost do not appear, the clinical signs are mild and the hernia does not bother. It can only be detected by chance, for example, during a medical ultrasound examination. Visual inspection and palpation will not give results, since the hernia is not palpable to the touch due to its deep location inside the thoracic region. It makes it difficult to recognize an axial hernia and the fact that it has the ability to periodically go back under the diaphragm.

A longer hernia or slippage of most of the stomach into the sternum provokes the onset of symptoms, so axial hernia is most often recognized already at later stages of development. Among the main signs that accompany the development of a hernia, the following are distinguished:

• periodic nature (usually occurs after eating and in the supine position);
• burning and pain behind the sternum;
• exacerbation of bronchitis, tracheitis (pancreatic juice enters the respiratory tract during belching);
• regurgitation (the flow of food from the stomach into the esophagus and oral cavity without vomiting);
• belching;
• dysphagia (a person cannot swallow as a result of cicatricial narrowing of the esophagus, which occurs due to constant inflammation of its mucosa with acid emissions).

If the disease was not detected in time, then its further development can lead to serious complications. It can be ulcers and bleeding on their background. Periodic bleeding, in turn, can lead to anemia (anemia). At the slightest hint of the development of a hernia, you should not delay the examination and subsequent treatment.

Diagnosis of a sliding hernia of the esophagus

Axial hernia can be diagnosed using radiography, esophageal manometry, fibroesophagogastroduodenoscopy, gastroscopy, esophagoscopy.

Treatment

conservative

In the early stages, surgery is rare. Most often, the doctor prescribes medication and a diet that involves exclusion from the diet:

• fatty (meat - pork, cakes, cream-based cakes with a high fat content, etc.);
• spicy (spicy seasonings, onion, garlic, black and red pepper);
• smoked (sausage, meat, fish, chicken products);
• fried (meat, potatoes, eggs, etc.);
• salty (cucumbers, tomatoes, sauerkraut, etc.);
• carbonated drinks (lemonade, mineral water);
• coffee, strong tea.

It is necessary to eat food in small portions (no more than 200 g at one time) 5-6 times a day. The stomach needs to be given time to process food and rest, so you should not take snacks, as they provoke the production of a large amount of gastric juice, which leads to heartburn.

You should not physically overstrain - this creates intra-abdominal pressure and provokes an increase in hernia. The number and intensity of loads should be kept to a minimum.

For occasional heartburn, it is best to sleep reclining on high pillows or raise the head of the bed if possible.

Foods to be excluded from the diet (photo gallery)

Coffee and tea
Carbonated drinks
salty foods Smoked products spicy seasonings Fatty food

Surgical intervention

When the disease is diagnosed at later stages, the hernia is removed with the help of surgical intervention. The most common methods of getting rid of a sliding hernia are:

• laparoscopy;
• Tope plastic.

Alternative medicine

The main aggravating symptom in the course of the disease is heartburn. You can eliminate it using folk methods. Herbal decoctions or teas are best suited for this:

• gentian tea will help not only eliminate heartburn and inflammation of the esophagus, but also improve digestion. A teaspoon of gentian is placed in one glass of water and infused over low heat for about 30 minutes. For taste, you can sprinkle with ginger and let stand for about 10 minutes. No need to stir. The remedy is taken before meals three times a day;
• calendula and chamomile have anti-inflammatory effects. Tea from these herbs will relieve inflammation of the esophagus and soothe the stomach. Half a teaspoon of chamomile and calendula is placed in a glass of boiling water. It is necessary to insist at least 20 minutes. After the resulting infusion is filtered and taken in a glass 3-4 times a day. During the period of exacerbation of heartburn, you can take more often.
• decoction of herbs for heartburn. A tablespoon of the collection is infused in 0.5 liters of boiling water for about 2–30 minutes. Strained infusion is taken 15-20 minutes before meals. You need to mix:
  • young nettle;
  • lemon balm;
  • oregano;
  • plantain;
  • St. John's wort.
• flaxseed soothes the stomach, reduces the acidity of its contents, relieves inflammation of the esophagus and heals the digestive system. A teaspoon of seeds is infused in a glass of hot water (no need to boil) for 30-40 minutes. You can wrap it in a towel to keep warm. The infusion is filtered and taken shortly before meals. You can also add linseed oil to food, but not more than 3 tablespoons per day.

Folk remedies for the treatment of illness (gallery)

Melissa infusion calendula tea Chamomile tea Gentian infusion Infusion of calendula

Diet after surgery

Compliance with the postoperative diet is necessary to reduce the degree of stress on the gastrointestinal tract. Fractional nutrition and the exclusion from it of products that provoke gas formation, contribute to constipation, etc. will help to achieve this.

What foods should not be consumed after surgery?

From the diet should be excluded:

• flour pastry (cookies, pies, cake, pancakes, pancakes, etc.);
• bran bread;
• fatty, smoked, salty, spicy, fried;
• legumes (peas, beans, etc.);
• citrus;
• tomatoes, cabbage, broccoli, carrots, garlic, onions;
• radish, turnip, radish;
• corn, millet, barley porridge;
• eggs;
• dairy products with a high percentage of fat;
• nuts, seeds, raisins, dried apricots, prunes;
• carbonated drinks, coffee, strong tea, juices with a high acid concentration.

Products prohibited for consumption after surgery (gallery)

Carbonated drinks Dried fruits Legumes
flour products Dairy products with a high percentage of fat

What foods can be consumed after surgery?

After surgery, it is best to use:

• low-fat broths;
• vegetable soups;
• boiled lean meat or fish;
• cottage cheese (low-fat);
• liquid cereals;
• dried white bread in a small amount;
• jelly (it is desirable to cook it not from braces containing dyes, but from fresh berries).

The use of vegetable fiber allows you to restore the functioning of the digestive tract, but excessive consumption of vegetables can lead to stagnation of coarse fiber and the formation of feces in the intestines.

Products approved for use in the postoperative period (gallery)

Berry kissel Gruel boiled fish Low fat broth boiled meat

The best way to prevent hiatal hernia is to maintain a healthy lifestyle. Abuse of alcohol and cigarettes, malnutrition and lack of sports loads on the body entails the development of multiple diseases of the digestive system, including axial hernia. At the first signs of the disease, you should seek the advice of a doctor and undergo a complete examination of the abdominal organs. A neglected disease leads to more serious complications, including death.

With sliding hernias one from the walls of the hernial sac it is formed by an organ adjacent to the sac, located retroperitoneally. These organs are most often the caecum, the ascending and descending sections (colon iliacum) of the large intestine, less often the bladder. The ureters, kidneys, uterus and its appendages can also descend, slide and exit through weak areas of the anterior abdominal wall, mainly in the inguinal region, less often under the inguinal ligament through the femoral canal.

Most often, sliding hernias are oblique right-sided, less often - straight and left; femoral sliding hernias are rare.

In connection with the mechanism of development and the prevailing anatomical relationships, sliding hernias are divided into three types: 1) ingraparietal hernias with a full hernial sac (hernias of the large intestine can also be included here)1; 2) paraperitoneal hernias with an incomplete hernial sac (hernias from slipping) - true sliding hernias; 3) extraperitoneal hernias, when the hernial sac is absent (prolapse of the bladder, kidneys, ureters, which can descend into the hernial orifice without exiting the peritoneal sac). The most common type of extraperitoneal hernia is bladder prolapse with direct or supravesical hernia (hernia supravesicalis). In rare cases, the ascending colon can also form an extraperitoneal sliding hernia with a mobile blind, as shown in Fig. 65 (Schaukelbruch - rocking hernia). This type of hernia belongs to the so-called hernias without a hernial sac.

Clinic and recognition.

Recognition of sliding hernias presents considerable difficulties. The clinical picture at first glance is not much different in its course and symptoms from ordinary inguinal hernias.

Attention should be paid to the age of the patient, the duration of the disease, the large size and peculiar consistency of the hernial protrusion, rumbling when trying to reduce, wide hernial ring, as well as dyspeptic syndrome. When the intestine slips, dysuric phenomena may indicate the possibility of a direct fit to the sliding organs of the bladder. Sliding hernias are infringed usually more often; the clinical course of their infringements is much more severe. With irreducible sliding hernias, which are more common, recognition is difficult.

It is important to pay attention to not quite the usual symptoms and the main thing to remember is the possibility of a sliding hernia.

Operations for sliding hernias of the colon. Due to the peculiarity of the surgical anatomy, these operations can present significant difficulties, especially with poorly reducible hernias of large size.

Operative methods for sliding hernias can be divided into the following groups:

1. Reduction of hernial contents en masse (reposition).
2. Peritonization of the slipped sections of the colon with their subsequent reduction into the abdominal cavity.
3. Fixation of the slipped section of the intestine to the abdominal wall in front of it.
4. Mesenteric plasty and fixation of the slipped area to the anterior surface of the posterior abdominal wall. The scheme according to M. I. Pototsky (Fig. 66) shows the main methods of surgical treatment of the most common sliding hernias of the colon.

Methods of surgical treatment of sliding hernias

1. Savario's method: the inguinal canal is opened, the hernial protrusion is released from adhesions to the transverse fascia, the hernial sac is opened, and after the sliding intestine is released and the opened sac is sutured, the latter, together with the intestine, is inserted into the abdominal cavity
2. Method B and vein (Beven): after reduction of the hernial contents and resection of the hernial sac, a purse-string suture is applied to the remnants of the hernial sac and the intestinal wall
3. The method of Barker (Barker), Hartmann (Hartmann) and Erke with a (Erkes): after resection of the hernial sac, the stump of the latter is sutured, and the long ends of the threads are passed behind the pupart ligament, possibly higher, through the anterior abdominal wall (back to front)

Due to the peculiarity of the anatomical and topographic conditions in sliding hernias, significant pathoanatomical changes, as well as the duration of the disease and the age of the patients (most often elderly people turn to the surgeon), these operations are technically quite difficult even for experienced surgeons, and relapses are often observed.

Prevention of dangerous complications in the operation of sliding hernias and the choice of the method of operation

1. With a large irreducible (or incompletely reducible) inguinal hernia in an elderly man, accompanied by severe pain, dyspeptic symptoms, a tendency to partial infringement, one must always remember about a sliding hernia.
2. If a sliding hernia is suspected, the anamnesis should be clarified in detail, a thorough examination should be carried out, including irrigoscopy, and, if indicated, cystoscopy and cystography. According to the data of the study, it is necessary to draw up a preliminary plan for the operation, to choose the most appropriate way to eliminate the hernia. In this case, the indication of surgical intervention, the age and general condition of the patient should be carefully weighed.
3. Carefully, in layers, carefully dissecting tissues, one must remember about the peculiar atypical anatomical relationships in sliding hernias, about the danger of damage to the intestines and bladder.
4. If the hernial sac has an unusual appearance, its wall is thick, “fleshy”, of an unusual color, bleeds easily, when it is isolated, without opening the sac, take it into the fold and feel it between the thumb and forefinger; with this technique, you can clearly feel the unusual pastosity of the wall of the "bag", and sometimes the pulsation of the vessels (which never happens when feeling the bag of an ordinary hernia). In such a situation, it is necessary to carefully open the bag along its medial surface in the thinnest area.
5. You should not strive to treat the hernial sac in the usual way (isolation and high neck ligation). This is not possible with sliding hernias, since the prolapsed intestine cannot be separated from the hernial sac; such preparation can lead to damage to the vessels that feed the wall of the colon. These vessels are located at the lateral surface of the "hernial sac" and can be overlooked. Viewed vascular damage can lead to necrosis of the colon with all the ensuing consequences up to death.
6. If a surgeon recognizes a sliding hernia only after significant organ damage or a violation of the vascularization of the intestinal wall, he must quickly decide to expand the access (herniolaparotomy) and eliminate a dangerous complication (careful suture of the damaged organ, if indicated, resection of the intestine).
7. A significant danger in the operation of a sliding hernia is an unrecognized injury to the bladder, which can be seen if the thinned wall of the bladder diverticulum protrudes into the hernial sac. In these cases, only preoperative cystoscopy (cystography) can help prevent a dangerous complication.

Sliding hernias are pathologies in which one wall of the hernial sac is an internal organ located retroperitoneally and partially covered by the peritoneum. For surgeons, these hernias present difficulties. They do not occur as often as usual, but for their successful treatment, the doctor must perfectly know and represent the anatomical features of sliding hernias. Without knowledge of the features, it is possible, through negligence, to open the bladder or intestinal wall instead of the hernial sac.

Predisposing factors

• Chronic constipation.
• Age changes.
• Bad habits.
• Inactive way of life.
• genetic predisposition.
• Overweight.
• Unbearable physical labor.
• Diseases of the spine.

There are many reasons for the formation of a sliding hernia. They may be related to the anatomical structure of the human body. Gender, age and physique also have a direct impact on the appearance of a hernia. Genetic predisposition manifests itself in 25% of cases. Most often, sliding hernias are diagnosed in children under one year old. But their maximum frequency occurs in people over 30 years old.

Increased intra-abdominal pressure can also cause the development of a hernia. Provoking factors include indigestion, coughing, problematic urination, hysterical screaming, wearing a tight bandage, childbirth, and hard work.

Reasons for weakening of the abdominal wall:

• pregnancy;
• elderly age;
• hypodynamia;
• injury to the abdominal wall;
• diseases that reduce muscle tone.

Sliding hernia classification

The contents of sliding hernias can be:

• bladder;
• kidneys;
• ureter;
• departments of the large intestine;
• small intestine;
• mother, etc.

According to the type of occurrence, they are found congenital and acquired. At first, protrusions of organs not covered by the peritoneum can only be called a hernia conditionally. But as they develop, they become overgrown with a hernial sac. According to the anatomical structure, they are divided into:

• ingraparietal- the intestine is fused by the mesentery with the hernial sac, against which the attached mesentery slips;
• paraperitoneal- the intestine is partially located behind the peritoneum, being the wall of the hernial sac;
• intraparaperitoneal- a sliding hernia is connected by a mesentery with a hernial sac;
• extraperitoneal- the intestine is located behind the peritoneum, while the absence of a hernial sac is noted.

Symptoms

• Heartburn.
• Burning pain in the hypochondrium or behind the sternum.
• Belching.
• Dysphagia, which is a swallowing disorder.
• Chronic bronchitis and tracheitis.

The clinical picture of this disease is due to the development of reflux esophagitis, which is the return of gastric contents into the esophagus. A high level of hydrochloric acid in the gastric contents leads to irritation of the esophageal mucosa, causing damage to its walls. This often causes ulcerative formations and erosions.

Sliding hernia causes pain behind the sternum, in the hypochondrium and epigastrium. In some cases, the pain extends to the area of ​​the scapula and left shoulder. Such symptoms are very similar to the signs of angina pectoris, so patients may mistakenly be registered with a cardiologist for a long period of time.

Increased pain can occur with a change in body position or during physical exertion. In this case, regurgitation, heartburn or belching may occur. The progression of the disease leads to the development of dysphagia.

With a sliding hernia, occult bleeding may occur. This can be determined by bloody vomiting or stools with blood clots.

As a rule, ulcers or erosions in the esophagus act as sources of bleeding. Another important sign that indicates hidden bleeding is anemia.

It is often difficult to make a diagnosis of a sliding hernia. Outwardly and in general manifestations, they almost do not differ from ordinary ones. But with a detailed history taking, the doctor may suspect or assume the absence of the peritoneum under the skin covering the prolapsed organs and prescribe an additional x-ray examination.

Diagnosis of the disease

To confirm or refute the diagnosis, the patient will have to undergo an x-ray examination and fibrogastroduadenoscopy. Such diagnostic methods make it possible to identify the expansion or shortening of the esophagus, its descent into the stomach.

• Examination of the patient.
• Detailed x-ray examination of the esophagus and gastrointestinal tract.
• Passage of esophagometry.
• Ultrasound procedure.
• CT scan.

Among these diagnostic methods, the most accurate is considered to be radiological. With the help of ultrasound, it is also possible to determine the location of the sliding hernia and the affected area, then it is difficult to guarantee accuracy in this case. True, computed tomography can give a good result. If it is possible to undergo such an examination, then the accuracy of diagnosis will be ensured.

Treatment

Treatment is performed surgically. The operation is difficult due to anatomical features, especially if the hernia is very large and cannot be reduced. Often during surgery, they perform:

• reduction of prolapsed organs;
• closure of the defect in the peritoneum;
• fixation of slipped organs;
• plastic surgery of the mesentery of the intestine.

To prevent the dangerous consequences of a sliding hernia, when diagnosing a disease, the doctor should always remember the possibility of developing a hernia without a hernial sac. In this regard, it is necessary to carefully study the patient's history and symptoms, not to neglect additional methods of examination. During the operation, tissue dissection must be carried out carefully, layer by layer.

If the organ wall is damaged, it is important to react quickly and decide on further actions: resection or herniolaparotomy of the damaged organ. The success of the operation largely depends on the experience and skill of the surgeon.

Conservative treatment

If the disease is at the development stage, then conservative therapy can bring good results, but only if the doctor's recommendations are followed. The principle of treatment is to eliminate heartburn (Motilium), pain (No-shpa) and other unpleasant symptoms.
To reduce acidity in the stomach, Kvamatel is sometimes prescribed. To protect the mucous membrane of the digestive tract, you can resort to the help of the drug De-nol. For treatment, you can use other medications:

• prokineniki (Domperidone);
• inhibitors (Omeprazole, Omez);
• antacids (Almagel, Maalox, Gastal).

If anemia is noted against the background of bleeding, the patient is recommended to take iron supplements. The patient should avoid serious physical exertion. During sleep, it is recommended to slightly raise the upper body. In addition to these rules, you will need to follow others:

• exclude spicy and smoked dishes from the diet;
• minimize the consumption of fatty foods;
• remove from the diet foods that provoke the production of gastric juice;
• give up smoking and alcohol.

It is also necessary to try not to overeat and adhere to proper nutrition according to the regimen. This will help prevent constipation and flatulence. But the main measure in the prevention of a sliding hernia is to strengthen the abdominal muscles.

hernia surgery

• Nissen method.

Cuffs are formed around the esophagus to prevent the contents of the stomach from being ejected directly into the esophagus. In this case, the upper part of the main digestive organ is located in the abdominal region, and the ends of the diaphragm are sutured. The result is a decrease in the diameter of the esophageal opening. Among the advantages of such an operation is a slight injury to the patient, a reduction in the period of stay in the hospital and a decrease in the risks of the consequences associated with the operation.

• Allison method.

The main essence of the operation is the reduction of the hernial orifice by suturing them.

• Belsey method.

In this case, the lower part of the esophagus is fixed along with the sphincter directly to the diaphragm, and the fundus of the stomach is fixed on the wall of the esophagus. The Belsi operation differs from the first method of treatment in the presence of pain.

• Gastrocardiopexy.

As a rule, patients are operated on under local anesthesia. The choice of anesthesia method depends on the operation itself. The age and condition of the patient is also taken into account. In complicated hernias, the operation is performed under spinal anesthesia or under local anesthesia with multicomponent anesthesia intravenously. But the best option is endotracheal anesthesia and adequate ventilation.

During the operation, an incision is made above the navel in the middle of the abdomen. Next, the upper part of the stomach is sutured along with the esophagus. This method of operation avoids possible complications.

The choice of the appropriate method of operation to remove a sliding hernia depends on its type and condition of the contents. With the wrong technique of surgical intervention, a violation of the integrity of the lumen of the organ, which acts as the wall of the hernial sac, can occur.

The opening of the bag should take place on the side opposite the slipped organ, and on its thinnest section. An important process during surgical treatment is the identification of particles of the spermatic cord. Next, the displaced intestine is carefully isolated, trying to avoid damage to the integrity of the walls and blood vessels that feed it or nearby organs. After that, the intestine is reduced into the peritoneal cavity.

If the presence of a large sliding hernia is noted, then the treatment of the hernial sac cannot occur in the usual way, since there is a high probability of deformation of the hollow organ.

Sewing and bandaging of the hernial sac is carried out near the intestine, more often from the inside, using a purse-string suture. The detected lesions on the intestine are sutured. Similar actions should be carried out in relation to the bladder.

If necrosis of the intestinal loop is detected, the specialist is obliged to resort to a median laparotomy, followed by resection of a segment of the strangulated intestine. When necrosis is observed on any wall of the bladder, it means that resection is carried out with the imposition of an epicystostomy. A Folley catheter may also be used to provide permanent catheterization of the bladder. But this method is acceptable only for women.