Hiatus hernia symptoms treatment. Surgical treatment of hernia. Causes and risk factors

Article publication date: 05/06/2015

Date of article update: 08.11.2018

Hernia of the esophagus - serious defeat digestive system. If you do not start hernia treatment esophageal opening diaphragm on time, or with inadequate therapy - severe consequences develop (erosion and ulcers of the esophagus, narrowing of the esophagus, bleeding,).

correct conservative treatment- symptomatic, carried out at home. Such therapy relieves a person of the symptoms of HH (restores the normal passage of food and prevents the reflux of bile into the esophagus). In 90% of cases, this is enough for the patient to lead full image life. But the very first attempt to interrupt treatment will provoke a relapse of the disease. The patient must follow a diet for life, take medication, lead a special lifestyle.

It is possible to restore elasticity to the ligaments of the food opening of the diaphragm and restore its normal functioning only with the help of an operation that is performed in 10% of cases (in the presence of complications or a severe course of the disease).

Three topical conservative methods:

Medications that reduce production of hydrochloric acid and contributing to the normalization of esophageal motility.

A diet that consists of products that reduce secretion gastric juice and gas generation. You need to eat fractionally.

Therapeutic exercise helps to restore the elasticity of the weakened ligaments of the food opening of the diaphragm.

Also used folk remedies that prevent heartburn, bloating and constipation. Reception of decoctions, teas and infusions stops belching, reduces acidity and prevents the contents of the stomach from being thrown into the esophagus. They are excellent medical aids. Remember: home treatment can take off unpleasant symptoms and only temporarily alleviate your condition - it is impossible to get rid of a hernia in this way.

Three methods of conservative treatment

1. Medicines

The first task of conservative treatment is to prevent the reflux of gastric contents into the esophagus, which causes serious damage to the mucous membrane. When performing this task, the symptoms of the disease (heartburn, belching, unpleasant feeling chest tightness and pain after eating). For this, appoint:

• Antacids (almagel, maalox, gastal) are drugs that bind hydrochloric acid, which is the main component of gastric juice.
• Medicines that can reduce the production of hydrochloric acid (omeprazole, esomeprazole, pantoprazole).
• Means that normalize the motility of the alimentary canal (metoclopramide, cisapride, domperidone). These drugs prevent the back flow of stomach contents into the esophagus.
• Histamine H2 receptor blockers (ranitidine, famotidine, roxatidine) act on the hydrochloric acid secretion center and help reduce its production and intake.

2. Therapeutic exercise

Physical therapy exercises are necessary to strengthen the ligaments. Gymnastics is performed on an empty stomach at least half an hour before meals. The first exercises are done lying down, then they move to a sitting position.

An example of the "first exercise lying down":

Starting position (IP) lying on your back, head and shoulders on the pillow. Put the middle and index fingers both hands under the ribs, on the midline of the abdomen. Take a breath. As you exhale, press your fingers on the peritoneum as deeply as possible. Carefully unbending your fingers, move the stomach to the left and down. Repeat 5-6 times.

Performing the first exercise

This exercise reduces pain and eliminates the feeling of a lump in the throat:

IP sitting on a chair. Relax as much as possible. Place the hands under the ribs so that the pads of the thumbs feel each other, and the rest of the fingers are parallel to the midline. Inhale and on the inhale pull the skin thumbs up. Exhale and as you exhale, press down with your thumbs as hard as you can, directing the pressure slightly down. Repeat 5-6 times.

Doing exercises to reduce pain and eliminate a lump in the throat

Important element therapeutic exercises – breathing exercises. It is done two hours after eating. It consists of 3 simple exercises:

3. Diet

Overeating and irregular meals are the main provocateurs of the disease. Without a diet, the treatment of a hernia of the food opening of the diaphragm is impossible, and at the very beginning of the formation of a hernia, diet is the only method of treatment.

Three principles of diet:

Regime compliance. The amount of food consumed at one time should not burden the stomach: eat 5-6 times a day, the amount of food at one time should not exceed 250 ml. The intervals between meals should be equal. Prepare dinner only from easily digestible foods.

Decreased acidity. Permanently eliminate foods that require increased output gastric juice: all spicy dishes, spices, smoked meats, sweet desserts and most confectionery. An excessive amount of gastric juice leads to its penetration back into the esophagus, which greatly harms the mucous membranes and leads to the formation of ulcers and erosions.

Reduction of gas formation and prevention of constipation. The formation of gases leads to an increase in pressure on the stomach. To exclude this moment, refuse from:

• cabbage,
• corn,
• legumes,
• whole milk,
• yeast baking,
• carbonated drinks.

Treatment with folk remedies

Herbal infusions and decoctions help to get rid of hernia symptoms.

Before using any recipe from the Internet or a book, be sure to consult a gastroenterologist. Herbs that help one person may harm another.

From heartburn helps decoction of licorice root and orange peels. Take equal parts of licorice root and dry orange peels. Pour water up to 2 cm above the mixture and simmer until the liquid has evaporated by half. Take three tablespoons before meals.

Bloating will prevent herbal collection from peppermint, valerian root and fennel fruit. Pour the mixture with boiling water and hold in a dark place until it cools completely. Drink morning and evening.

The composition of cranberries, aloe and honey will relieve burping. Pass all components through a meat grinder, pour warm water and wait 6 hours. Pesto composition gradually throughout the day.

Surgery

When conservative treatment fails desired result, the symptoms of HH intensify, and against this background there is a severe lesion of the esophagus - gastroenterologists strongly recommend the operation.

(if the table is not fully visible, scroll to the right)

The operation - suturing the hernial opening - is carried out in three ways (the choice of method depends on the patient's condition, his age, and the size of the hernia):

open cavity method,

laparoscopically,

by mini access.

The recovery period directly depends on the method of the operation. After abdominal surgery the patient spends a day in the intensive care unit, then he is transferred to the ward. Getting up is allowed on the 5th day, and the stitches are removed on the 7th day. Full recovery body ends after 4 weeks.

After laparoscopy, the recovery time is halved. In the evening on the day of the operation, the patient is allowed to get up, and he is discharged 3–5 days after the operation.

It is necessary to follow a diet and follow the special prescriptions of a doctor for at least 6 months. Then the person gradually moves to a normal way of life.

The result of surgical treatment of HH: the cuff is formed from the stomach, prevents the reflux of stomach contents into the esophagus

Summing up

Remember that conservative treatment of a hernia of the alimentary opening of the diaphragm will be effective only with the strict intake of all prescribed medications, lifelong diet and daily routine. If you are not ready to constantly limit yourself, you should consider surgery.

Finally, the good news: in modern pharmacology, drugs without side effects and not addictive. This is a big step forward in the treatment of HH, as many problems arise during therapy due to the body's addiction to certain medications, which need to look for an alternative.

Owner and responsible for the site and content: Afinogenov Alexey.

Hernial protrusion, which is formed when anatomical structures are displaced into the chest cavity, which in the normal position are located under the diaphragm - the abdominal segment of the esophagus, the cardial section of the stomach, intestinal loops. There is chest pain, heartburn, regurgitation, dysphagia, hiccups, arrhythmia. Diagnosis involves x-rays of the esophagus and stomach, esophagomanometry, esophagogastroscopy. Treatment may include pharmacotherapy for gastroesophageal reflux or surgical tactics– plastic surgery diaphragmatic hernia.

General information

Hernias of the esophageal opening of the diaphragm in modern herniology are quite common. The likelihood of diaphragmatic hernia formation increases in proportion to age - from 9% in people under 40 years old to 69% in people over 70 years old. Most often, a hernia of the esophagus is formed in women. In half of the cases, the disease is asymptomatic and remains unrecognized. Sometimes patients are treated for a long time by a gastroenterologist for concomitant diseases that determine the leading clinical manifestations - chronic gastritis, cholecystitis, stomach ulcers.

The reasons

Paraesophageal hernia can be congenital or acquired. In children, the pathology is usually associated with an embryonic defect - shortening of the esophagus and requires surgical intervention at an early age. Acquired hernias are caused by involutive changes - developing weakness ligamentous apparatus esophageal opening of the diaphragm. With age, the connective tissue structures that hold the esophagus in the diaphragmatic opening undergo dystrophic processes, loss of elasticity and atrophy.

A similar situation is often observed in asthenic, detrained individuals, as well as people suffering from diseases associated with weakness. connective tissue(Marfan syndrome, flat feet, varicose veins, hemorrhoids, intestinal diverticulosis, etc.). In this regard, paraesophageal hernia often accompanies femoral hernia, inguinal hernia, hernia of the white line of the abdomen, umbilical hernia.

Factors that increase the risk of developing a hernia are circumstances accompanied by a systematic or sudden critical increase intra-abdominal pressure: chronic constipation, indomitable vomiting, flatulence, ascites, severe physical work, simultaneous lifting of a heavy load, sharp bends, blunt abdominal trauma, severe obesity. According to available data, about 18% of women with repeated pregnancies suffer from diaphragmatic hernia. The rise in intra-abdominal pressure can be facilitated by a strong and prolonged cough in chronic obstructive bronchitis, bronchial asthma and other non-specific lung diseases.

Also, dysmotility predisposes to the development of a hernia. digestive tract with hypermotor dyskinesia of the esophagus, concomitant peptic ulcer of the duodenum and stomach, chronic gastroduodenitis, pancreatitis, calculous cholecystitis. The occurrence of hernias is promoted by a longitudinal shortening of the esophagus due to its cicatricial-inflammatory deformity, which has developed as a result of reflux esophagitis, esophageal peptic ulcer, chemical or thermal burn. A direct consequence of the weakening of the ligamentous apparatus of the diaphragm is the expansion of the esophageal opening and the formation of a hernia gate, through which the abdominal portion of the esophagus and the cardial part of the stomach prolapse into the chest cavity.

Classification

On the basis of radiological signs and the volume of displacement of the stomach into the chest cavity, modern abdominal surgeons and gastroenterologists distinguish three degrees of hernial protrusion:

• I degree. The abdominal part of the esophagus is located above the diaphragm, the cardia is located at the level of the diaphragm, and the stomach is directly adjacent to it.
• II degree. There is a displacement of the abdominal esophagus into the chest cavity and the location of the stomach in the region of the esophageal opening of the diaphragm.
• III degree. AT chest cavity there are all subdiaphragmatic structures - the abdominal part of the esophagus, cardia, fundus and body of the stomach (sometimes the antrum of the stomach).

In accordance with the anatomical features, sliding, paraesophageal and mixed diaphragmatic hernias are distinguished. With a sliding (axial, axial) hernia, there is free penetration of the abdominal part of the esophagus, cardia and fundus of the stomach through the esophageal opening of the diaphragm into the chest cavity and an independent return (when changing body position) back to abdominal cavity. Axial hernias occur in most cases and, depending on the displaced area, can be cardiac, cardiofundal, subtotal or total gastric.

Paraesophageal hernia is characterized by the location of the distal part of the esophagus and cardia under the diaphragm, but the displacement of part of the stomach into the chest cavity and its location above the diaphragm, next to thoracic region esophagus, i.e., paraesophageal. There are fundal and antral paraesophageal hernias. With a mixed hernia, axial and paraesophageal mechanisms are combined. Also, a congenital short esophagus with an "intrathoracic" location of the stomach is isolated in a separate form.

hernia symptoms

About half of the cases are asymptomatic or are accompanied by mild clinical manifestations. A typical sign pathology is considered a pain syndrome, which is usually localized in the epigastrium, spreads along the esophagus or radiates to the interscapular region and back. Sometimes the pain can be girdle in nature, resembling pancreatitis. Often there are chest pains (non-coronary cardialgia), which can be mistaken for angina pectoris or myocardial infarction.

Differential features pain syndrome with a hernia of the esophageal opening of the diaphragm are: the appearance of pain mainly after eating, physical activity, with flatulence, coughing, in the supine position; reduction or disappearance of pain after belching, deep breath, vomiting, changes in body position, water intake; increased pain when bending forward. In case of infringement of the hernial sac, intense cramping pains behind the sternum with irradiation between the shoulder blades, nausea, vomiting with blood, cyanosis, shortness of breath, tachycardia, hypotension.

In a third of patients, the leading symptom is a violation heart rate according to the type of extrasystole or paroxysmal tachycardia. Often, these manifestations lead to diagnostic errors and prolonged unsuccessful treatment by a cardiologist. Since a hernia naturally leads to the development of gastroesophageal reflux disease, a group of symptoms associated with indigestion arises. Patients, as a rule, complain of belching of gastric contents or bile, a feeling of bitterness in the mouth, belching with air. Often there is regurgitation recently accepted food without previous nausea; regurgitation often develops in horizontal position, at night.

Dysphagia is a pathognomonic manifestation of the disease. food bolus along the esophagus. This manifestation more often accompanies the intake of semi-liquid or liquid food, too cold or hot water; develops with hasty eating or psychotraumatic factors. Esophageal hernia is also characterized by heartburn, hiccups, pain and burning in the tongue, and hoarseness.

Complications

When gastric contents enter Airways tracheobronchitis, bronchial asthma, aspiration pneumonia may develop. AT clinical picture often celebrated anemic syndrome associated with hidden bleeding from the lower esophagus and stomach due to reflux esophagitis, erosive gastritis, peptic ulcers of the esophagus.

Diagnostics

Usually, hernias are first detected during chest x-ray, x-ray of the esophagus and stomach, or during endoscopic examination (esophagoscopy, gastroscopy). X-ray signs pathologies are the high location of the esophageal sphincter, the presence of the cardia above the diaphragm, the absence of the subphrenic esophagus, the expansion of the diameter of the esophageal opening of the diaphragm, the retention of barium suspension in the hernia, etc.

During endoscopy, as a rule, the displacement of the esophageal-gastric line above the diaphragm, signs of esophagitis and gastritis, erosion and ulcers of the mucosa are determined. To exclude tumors of the esophagus, endoscopic biopsy of the mucosa and morphological study biopsy. In order to recognize latent bleeding from the gastrointestinal tract, feces are examined for occult blood.

A special place in the diagnosis of hiatal hernia is given to esophageal manometry, which allows assessing the state of the sphincters (pharyngeal-esophageal and cardiac), motor function esophagus at different levels (duration, amplitude and nature of contractions - spastic or peristaltic), as well as to track the effectiveness of conservative therapy. To study the environment of the gastrointestinal tract, impedancemetry, gastrocardiomonitoring, intraesophageal and intragastric pH-metry are carried out.

Esophageal hernia treatment

Treatment begins with conservative measures. Since the symptoms of gastroesophageal reflux come to the fore in the clinic, conservative treatment is mainly aimed at eliminating them. The complex drug treatment includes antacids (aluminum and magnesium hydroxide, aluminum hydroxide, magnesium carbonate, magnesium oxide, etc.), H2-blockers histamine receptors(ranitidine), inhibitors proton pump(omeprazole, pantoprazole, esomeprazole). It is recommended to normalize weight, follow a sparing diet, fractional nutrition with the last meal no later than 3 hours before bedtime, sleep in a bed with a raised headboard, exclusion of physical activity.

To surgical methods resorted to with complicated forms of hernia (narrowing of the esophagus, infringement of diaphragmatic hernia), the failure of drug therapy or dysplastic changes in the esophageal mucosa. Among the whole variety of methods, the following groups of interventions are distinguished: operations with closure of the hernia orifice and strengthening of the esophagophrenic ligament (diaphragmatic hernia repair, crurorrhaphy), operations with fixation of the stomach (gastropexy), operations to restore an acute angle between the fundus of the stomach and the abdominal esophagus (fundoplication ). When forming cicatricial stenosis a resection of the esophagus may be required.

Forecast and prevention

The complicated course of a hernia is associated with the likelihood of developing catarrhal, erosive or ulcerative reflux esophagitis; peptic ulcer of the esophagus; esophageal or gastric bleeding; cicatricial stenosis of the esophagus; perforation of the esophagus; infringement of a hernia, reflex angina pectoris. With a long course of esophagitis, the likelihood of developing esophageal cancer increases. After surgery, relapses are rare.

Prevention of hernia formation, first of all, consists in strengthening the abdominal muscles, physical therapy classes, treatment of constipation, exclusion of heavy physical exertion. Patients with diagnosed diaphragmatic hernia are subject to dispensary observation at the gastroenterologist.

A hernia of the esophageal opening of the diaphragm (HH) develops due to the displacement of organs that are normally located under the diaphragm in the chest cavity. The upper part of the stomach, the abdominal part of the esophagus, intestinal loops can change the location.

The figure schematically depicts a hiatal hernia

This disease is often diagnosed by gastroenterologists, and the older the person, the more likely he is to develop a hernia of the alimentary opening of the diaphragm. So, among patients with this disease, about 10% are under 40 years old and approximately 70% of those who have crossed the 70-year mark. This pathology of the diaphragm is more common among the female population, and the patient may not even be aware of the presence of a hernia of the esophageal part of the diaphragm.

You can learn more about the causes and treatment of such hernias from the video:

Why does a diaphragmatic hernia of the esophagus occur?

Like many pathologies, a hernia of the diaphragm can be in a person from birth, or it can appear already in adulthood.

The development of the disease during fetal development is associated with an embryonic defect, which consists in a decrease in the length of the esophagus. This pathology of the digestive tract requires operable treatment in the first years of a child's life.

The causes of acquired diaphragmatic hernia of the esophagus are associated with weakness of the ligaments of the diaphragm in the region of the esophagus. As a person ages, the connective tissue in many organs and systems undergoes dystrophy, atrophy and loss of elasticity. The weakened system of the diaphragmatic ligaments forms the so-called hernial gate, through which the abdominal organs protrude into the chest.

But not only age contributes to the development of pathological changes in the diaphragm. Some other types of hernias lead to weakness of the connective tissue (umbilical, femoral, inguinal, etc.).

Increase the risk of disease reasons for which systematically or suddenly there is an increase in intra-abdominal pressure. These include:

• frequent vomiting;
• excessive gas formation in the intestines;
• regular constipation;
• excessive physical stress;
• lifting and moving heavy objects;
• last stage of obesity.

In addition, a strong and prolonged cough provoked by asthma can increase the intra-abdominal pressure, obstructive bronchitis and some other respiratory diseases. According to official statistics, diaphragmatic hernia develops in about 20% of women who are re-carrying a child.

Another cause of diaphragmatic hernia can be considered impaired motility of the digestive tract. It can be called:

• dyskinesia of the esophagus, which often occurs against the background of gastric and duodenal ulcers;
• relapses of gastroduodenitis;
• inflammation of the pancreas in a chronic form;
• calculous cholecystitis.

What is HH, people with a longitudinal shortening of the esophagus, which could lead to its cicatricial-inflammatory deformity, which occurred due to thermal or chemical burns, can know firsthand.

Types of hernia of the food opening of the diaphragm

Depending on the anatomical features, in medicine, 3 types of pathological condition of the food diaphragmatic opening are distinguished:

• fixed (paraesophageal) hernia;
• non-fixed (sliding, axial) hernia;
• mixed type of protrusion.

A fixed hiatal hernia differs from a sliding hernia in that the distal part of the esophagus and cardia are located under the diaphragm, while the upper part of the stomach is displaced into the chest cavity and is in close proximity to the thoracic segment of the esophagus.

Axial hiatal hernia is characterized by the fact that the abdominal part of the esophageal tube and the upper segment of the stomach freely penetrate from the abdominal into the chest cavity, but also independently return to their normal position. This type of pathological protrusion occurs in the practice of gastroenterologists more often than other varieties. In turn, sliding hernia includes cardiofundal, subtotal, total gastric and cardiac hiatal hernia.

The mixed type of HH combines both axial and paraesophageal varieties of pathology. An anomaly is a separate form of the disease. prenatal development- a short esophagus, in which the stomach has an "intrathoracic" position.

There is also a classification of this disease according to the degree of displacement of the stomach into the chest cavity. It includes 3 degrees of pathology:

1. In the first degree, the abdominal section of the esophageal tube is located above the diaphragm. It is adjacent to the stomach.
2. The second degree is characterized by the transition of the abdominal region of the esophagus and the displacement of the stomach directly to the esophageal opening.
3. If the disease has reached the third degree, then the above anatomical structures, which are normally located under the diaphragm, enter the chest cavity.

The photo shows the couple walking in the park.

What are the symptoms of HH

Symptoms of a hernia of the esophageal opening of the diaphragm are often mild or absent altogether, and therefore a person may not even be aware of the development of a problem in his internal organs.

First of all, hiatal hernia symptoms are manifested in the occurrence pain, which are localized in the lower part of the sternum, along the esophagus tube, and give into the area between the shoulder blades on the back. In some cases, the pain encircles the body at the level of the diaphragm, resembling the manifestations of pancreatitis.

Often, a patient with pathologies in the diaphragm area may experience pain similar to that during angina pectoris or myocarditis. Approximately one third of people with HH suffer from an abnormal heart rhythm - a condition close to extrasystole or tachycardia develops. Because in this case plays important role differential diagnosis of a hernia of the esophageal opening of the diaphragm in order to correctly determine the nature of the pathology in the patient.

It is natural that the displacement of organs gastrointestinal tract(GIT) from the abdominal to the chest cavity negatively affects the very act of digestion. There are a number of clinical manifestations that indicate this. These include belching with a hint of bile or stomach contents, a bitter taste in oral cavity belching air. A very common manifestation of the disease is the sudden regurgitation of recently eaten food, and without prior nausea. The last symptom occurs, as a rule, when a person is in a prone position.

A characteristic sign for the protrusion of the diaphragmatic esophageal opening is the difficulty in passing food from the oral cavity through the esophagus into the stomach. Often this applies to liquid dishes, too cold or hot drinks.

An indirect sign of the disease can be attacks of heartburn, hiccups, a burning sensation in the tongue, a change in voice. If the contents of the stomach enter the respiratory tract, the patient may experience asthma, aspiration-type pneumonia, and tracheobronchitis. If there is occult blood loss from the lower part of the esophageal tube, the patient will develop signs of anemia.

In the photo, the doctor performs an endoscopy of the stomach

How to diagnose displacement of internal organs

As mentioned above, a hernia of the esophageal opening of the diaphragm can develop without any striking manifestations, and therefore many patients learn about the problem directly during the gastroenterological examination. This may be an x-ray of the chest, esophagus, stomach, or an endoscopy procedure.

During an x-ray examination, a hernia in the diaphragm can be identified by the following signs:

• the esophageal sphincter is unnaturally high;
• the subdiaphragmatic part of the esophageal tube is not detected;
• food opening in the diaphragm is enlarged in size.

Endoscopic signs may be as follows:

• the esophageal-gastric line has shifted to the area above the diaphragm;
• symptoms similar to those of gastritis, erosion and peptic ulcer disease.

If a hiatal hernia is suspected, the diagnosis should be differential so as not to confuse the pathology with another disease. So, with the help of endoscopic biopsy, it is possible to exclude an oncological process in the tissues of the esophagus. To determine if the patient has hidden internal bleeding, his feces are taken for analysis for the presence of red blood cells.

One of the most effective methods for diagnosing hiatal hernia is esophageal manometry. This study assesses the functionality of two sphincters - cardiac and pharyngeal-esophageal, can characterize the movement of food through the esophageal tube. Additionally, an environmental analysis of the gastrointestinal tract is carried out, namely, samples of the contents of the esophagus and stomach.

How to treat HH

After the patient has been diagnosed, the attending physician prescribes conservative therapy for him. First of all, this is the use of medications, including antacids and histamine receptor blockers.

For hiatal hernia, treatment should include normalization of the patient's weight if he has signs of obesity. Physical exercise must be excluded completely so as not to aggravate the pathological process.

This video shows how the Nissen fundoplication works:

Has a special place proper diet with a hernia of the esophageal opening of the diaphragm. So, meals should be fractional (you need to eat at least 6 times a day in small portions), and the last meal should be no later than 3 hours before bedtime. Food should not be washed down, just as it is unacceptable to overeat. Otherwise, the patient may begin to vomit without prior nausea.

In order to effectively treat a hernia of the esophagus, smoked meats, too fatty and spicy dishes, alcoholic drinks. Nutrition for hiatal hernia should help normalize intra-abdominal pressure, enter the body required amount nutritional components, prevent the development of flatulence, prevent constipation.

Surgical treatment of a hernia of the esophageal opening of the diaphragm is indicated for complications of hernia disease, as well as for ineffective use. conservative ways therapy. To date, there are several methods by which it is possible to remove a hernia of the esophageal opening of the diaphragm:

• reduction of the gate of the hernial protrusion with the strengthening of the ligamentous apparatus of the diaphragm;
• fixation of the gastric sac;
• prompt recovery acute angle between the esophagus and the gastric wall;
• resection of the esophagus.

But the operation of a hiatal hernia is a radical method of therapy, which doctors turn to as a last resort.

With this disease, home treatment should be limited to proper nutrition. Any attempts at self-treatment can exacerbate the problem, cause allergic reaction and only harm the patient more. Therefore, the treatment folk remedies with this disease, if it can be used, then only after consulting with the attending physician.

A hernia is a protrusion of an organ or part of it through crevices in the cavity, subcutaneous and intermuscular spaces, internal pockets in almost any part of the body. Hernia of the esophagus is quite rare disease and appears in 60% of people after fifty years.

A hiatal hernia (HH) occurs when the upper part of the stomach pushes up into the chest through a small hole in the diaphragm. The diaphragm is the muscle that separates the abdomen from the chest. The opening through which a hernia moves is called a fissure. HH leads to the retention of acid and other contents, as the stomach is in a clamped position. These acids and other substances can easily back up – reflux (a condition in which food or stomach acid can back up from the stomach into the esophagus).

Do not confuse hiatal hernia with gastroesophageal reflux disease (reflux)!

Reasons for the appearance

Hernias occur mainly in people over fifty years of age. The exact cause of many hernias is not known. But it could be an injury or other injury that weakens the muscle tissue, allowing the stomach to push through the diaphragm. It also provokes the appearance of a hernia too great pressure on the muscles around the stomach. Similar actions occur when:

• chronic cough;
• vomiting
• constipation;
• lifting heavy objects;
• obesity
• overeating;
• congenital abnormally large cleft;
• smoking.

Types of hiatal hernias

There are such main types of hernias: sliding food hernia and fixed (paraesophageal) hernia.

sliding hernia of the esophagus is the more common type. In this type, the stomach periodically slides up into the chest through a small hole in the diaphragm, but returns to its place. Sliding hernias small in size and in most cases do not cause pain symptoms. They may not require special treatment.

fixed(paraesophageal) hiatal hernia is less common. In this case, part of the stomach is pushed through the diaphragm and remains there. As a rule, such hernias are not considered serious illness. However, there is a risk that blood flow to the stomach may be blocked, which can cause serious injury and is a medical emergency.

Symptoms

Common symptoms include:

• heartburn that increases when bending over or lying down;
• chest pain;
• pain in the epigastrium;
• belching;
• swallowing problems;
• regurgitation (reflux of food from the stomach into the esophagus);
• anemia (decreased hemoglobin in the blood).

Most small hernias do not show any signs or symptoms; larger hernias can cause nausea and vomiting.
Note! Similar symptoms can also be a sign of heart problems or peptic ulcers.

Diagnostics

HH can be found during any medical procedure when the doctor examines the cause of heartburn, acid reflux, pain in the chest or upper abdomen.
The patient is prescribed blood tests (hemoglobin is important), ultrasound of the abdominal organs, MRI or CT of the upper digestive tract to determine the location of the stomach.

Also diagnostic methods include various tests to confirm the presence of a hiatal hernia:

Treatment

The specific treatment for HH is determined by the treating physician based on several factors: general state health, anatomy, the size and location of the hernia, the presence of a symptom of acid reflux. This may include advice on lifestyle changes and medications, or surgery. At acute conditions when the stomach and abdominal organs suffer, treatment is only surgical.

Non-surgical treatment of hernia of the esophagus

Many people do not experience any of the symptoms associated with HH. The patient switches to fractional meals in small portions. It is recommended to eat 5-6 times a day, the last - four hours before bedtime. Limitation fatty foods, acidic foods (citrus fruits and juices). Products containing caffeine and alcoholic beverages are excluded. The category of restrictions includes fresh bread and flour products, spices, spices, sauces and carbonated drinks. If the patient is overweight, then it is desirable to bring the weight back to normal and maintain it. It is also worth giving up smoking, and sleeping in a slightly elevated position.

Medications your doctor may prescribe:

• antacids to neutralize stomach acid (maalox, almagel, phosphalugel);
• H2 receptor blockers (omeprazole, pantoprazole, esomeprazole);
• prokinetics (motilium, cerucal).

Medications are used strictly according to the doctor's prescription![

Surgical treatment

Surgical intervention may be recommended in the absence of the effect of conservative (drug) treatment, complication of GERD (gastroesophageal reflux disease), as well as if there is a need to consult a thoracic surgeon.

Before the operation, the patient must undergo an examination, which consists in taking detailed and biochemical blood tests, a coagulogram, a Rh group, RW, and a urine test. Esophageal manometry (to measure pressure in the esophagus) or pH monitoring (to see how much stomach acid is returning to the esophagus), endoscopy, x-ray of the esophagus are prescribed. If the patient is a woman in the early stages of pregnancy, be sure to immediately notify the doctor. You may need to stop taking aspirin, ibuprofen, vitamin E, or any other supplement or drug that affects blood clotting a few days before surgery. Three days before the operation, vegetables, fruits, bread and bakery products. Before the operation, a light dinner (kefir, cottage cheese) is allowed the day before, later in the evening they put cleansing enema(1.5 liters of liquid).

The operation is performed on an empty stomach. Drink and eat 7-8 hours before it.

Some types of surgery for this condition include: repairing weak muscles in the esophagus, putting the stomach back in place, and closing the cleft to normal size 4 cm. In order to perform the operation, doctors either make a standard incision in the chest or abdomen, or use a laparoscopic method, which reduces recovery time.

Fundoplication operations are performed according to Nissen, according to Tope. To date, there is another technique - an operation using the EsophyX apparatus. Operations are carried out at the time general anesthesia usually takes 2 to 3 hours.

Open method through an incision in the abdomen according to Nissen

• mobilization of the esophagus, legs of the diaphragm, stomach bringing down into the abdominal cavity;
• suturing the esophageal opening of the diaphragm;
• reinforcing the seams with Mesh mesh (if necessary);
• forming a cuff around the esophagus from the gastric fundus to create an anti-reflux valve. The surgeon will make one big surgical incision in a stomach.

Laparoscopic Nissen method

The surgeon makes 3 to 5 small punctures in the abdomen using a laparoscope. A thin tube with a tiny camera at the end is inserted through one of these punctures, and through the other surgical instruments. The laparoscope is connected to a video screen in the operating room, which makes it possible to see the progress of the operation on the monitor. After release from the adhesions, the esophagus and the upper part of the stomach descend into the abdominal cavity. Then the cleft in the diaphragm is sutured to the desired size and a cuff is created from the walls of the stomach.

The operation takes about two hours and is performed under general anesthesia. The least traumatism with this method allows you to reduce the stay in the hospital and shorten the recovery period.

Video

This video shows the progress of the laparoscopic Nissen operation.

Fundoplication according to the Toupet method

During the operation, the fundus of the stomach is rotated 270 degrees relative to the esophagus. Thus, the possibility of a gag reflex and belching (protective mechanisms of the stomach) is preserved.

Endoluminal fundoplication

This is a new procedure that can be done without punctures or incisions. It is performed using the EsophyX apparatus. A special camera on a flexible instrument (endoscope) is inserted down through the mouth into the esophagus. At the end of the endoscope there is an esofix nozzle. After being introduced into the stomach, it stitches its wall with clips from the inside, forming a fold right size and the hernia is eliminated.

Video

Video about the operation of a hernia of the esophagus through the esophagus itself using the Esophy X gastroscope.

After removal of the hernia, the patient is in the hospital under observation for a day or two. He is prescribed antibiotics, anti-inflammatory and pain medications, diet and exercise.

Diet after surgery:

• no more than 250-300 ml of water on the first day;
• low-fat soup fractionally on the second day;
• then fractionally soft boiled food (porridge).

Food must be at body temperature, portions are small. Then the patient, under the supervision of a doctor, will gradually return to their usual diet. In order to avoid complications and relapses, it is advisable to adhere to nutrition as in the non-surgical treatment of HH.

Folk methods of treatment

Not last place in the treatment of HH folk methods. Funds traditional medicine inhibit the production of gastric juice, improve gastric motility and relieve constipation. For the treatment of hernia, you can use the following compositions:

Treatment with folk remedies is desirable to coordinate with the attending doctor.

Exercises for HH

Target therapeutic gymnastics with this disease - to achieve normal operation motor function of the stomach and intestines, eliminate or reduce flatulence, increase the contraction of the lower esophageal sphincter, increase the power of the diaphragm. Training can be carried out two to three hours after eating.

It is necessary to start the exercise therapy course (physiotherapy course) from a lying position on the right side, the upper part of the body is raised 20-25 cm from the floor. The main attention is paid to breathing with the stomach and in the first lessons they learn to do it correctly:

• about inhalation, blow forward as much as possible abdominal wall and fix the position for two to three seconds;
• on exhalation, relax the abdominal wall, it cannot be retracted;

Training is carried out for 10 - 15 minutes 3 p. in Week.

Then, during exhalation, the abdominal wall must be retracted. We do and gradually increase the amplitude of movements. If in the process of training there is no heartburn or belching, then the exercise is performed correctly.

Later, the complex is gradually introduced exercise:

• flexion - extension of the legs in a prone and kneeling position;
• body turns lying on the back, then alternately on the right and left side;
• turns and tilts of the body;
• jogging;
• squats;
• walking.

Training on different simulators is excluded in order to avoid pressure under the diaphragm. All relaxation exercises are welcome. Also recommended:

• swimming;
• massage of the abdomen and lumbosacral zone;
• massage of the abdomen with a ball;
• self-massage of the abdomen clockwise around the navel;
• cycling in an upright position.

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