3.4 HIATUS HERNIA
This is a
herniation of the stomach
through the oesophageal
hiatus of the diaphragm.
- Type 1 hernia is the more common variety and allows the
stomach
to slide up into
the thorax (Sliding hernia)Fig. 15.7
The symptoms are of retrosternal burning after a heavy
meal or on
lying down, these symptoms are because of reflux of
acid gastric
content into the oesophagus.
The acid gastric
content causes oesophagitis, the hernia
is
diagnosed on radiology
(barium study) and if the patient
is
symptomatic, requires treatment for oesophagitis.
Type II hernia
is rare and also referred to
as rolling or
paraoesophageal hernia,this is a true hernia and has a peritoneal
sac. Fig. above
Symptoms of reflux
are usually absent and in fact
it may be
completely asymptomatic.
If
symptomatic the patient complains
of fullness after meals,
dysphagia,there may also be stasis.
Treatment involves
surgical reduction of the hernia excision
of
the sac and repair of the defect in the diaphragm.
TREATMENT OF REFLUX : Medical
To reduce regurgitation
* Elevation of
Head end of bed
* To reduce
evening meal size
* To sleep at
least two hours after last meal of the day
* Antacids to be
taken 1 hour after meals
* Cimetidine may
be tried to reduce gastric acidity
SURGERY (ANTIREFLUX)
Surgery is aimed
at creating a valve mechanism at the cardia
by
wrapping the stomach
around the oesophagus
in the abdomen
(Nissens)
Operative
correction of esophageral hiatal hernia should
-
return the herniated content to its
anatomically correct position below the diaphragm
-
repair the hernia defect
-
prevent recurrence while mainimizing
associated morbidity.
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