Gastric Hernia and Its Treatment
Although hiatal hernia has been known for many years, it has been on the agenda again in recent years due to its association with gastroesophageal reflux disease. Most of the time, they do not cause a specific complaint in the patient and are usually diagnosed randomly. According to radiological studies, hiatal hernia, the incidence of which increases with age, is observed in approximately 10% of adults (3-20%). almost half of people over the age of 60 have a hiatal hernia, which can be of varying degrees. Only about 1/4 of adults with a hiatal hernia complain of a burning sensation in the chest or the arrival of stomach contents into the mouth (gastroesophageal reflux).
A dome-shaped compartment in the November muscle structure called the midriff separates our lungs from the abdominal area. When a person takes a deep breath, the midriff contracts and becomes flat. By doing this, it allows the lungs to fill with air. A small opening on the left side of the diaphragm (hiatus & slit) allows the esophagus to come from the chest cavity into the abdominal cavity and unite with the stomach. This opening, called hiatus, is small and surrounds the esophagus. The stomach is located under the midriff.
What are the causes of hiatal hernias?
In some people, the muscle and connective tissue that forms this opening in the diaphragm through which the esophagus passes are weak and November is suitable for expansion. When the slit reaches a sufficient width, a part of the stomach rises above the midriff. Accepted risk factors include obesity, excessive heavy lifting exercises, and straining. Dec. For whatever reason, as a result, a part of the stomach moves up from the enlarged and weakened hiatus, herniating into the rib cage, and thus a hiatus hernia (gastric hernia) occurs.
How many types of hiatal hernias are there?
Sliding hiatus hernia (Sliding type gastric hernia) : In the most common type of sliding type hiatal hernia, the stomach overflowing into the rib cage shows a bell-shaped expansion, limited by the midriff opening from its lower part. These hernias are usually small, but sometimes they can reach the size of an orange, and reflux symptoms may occur. (See the figure above),
Paraesophageal hernia (Rolling hiatal hernia): In this type, part of the stomach slides into the chest cavity, passing through another opening in the diaphragm, except for the opening through which the esophagus passes. In this type, reflux symptoms are not seen because the part where the stomach and esophagus meet remains in its normal position under the diaphragm.
What are the symptoms of a hiatal hernia?
A hiatal hernia usually does not give any symptoms. Especially as a result of the stomach contents escaping back into the esophagus by lying down or leaning forward, patients complain of the burning and sour feeling they feel behind the breastbone or the mouth of what they eat (see Fig. gastroesophageal reflux disease). More rarely, there may be gagging and then vomiting. Some patients may experience coughing, shortness of breath and asthma-like respiratory problems that occur at night. Long-term acid reflux can cause erections in the esophagus and bleeding. As a result, symptoms such as fatigue, weakness due to iron deficiency anemia may occur in patients. After a long-term and untreated reflux disease, narrowing at the lower end of the esophagus (peptic stricture) and related swallowing difficulties may develop. Hiatal hernias do not cause abdominal pain and indigestion. Rarely, patients with a large hiatal hernia may experience symptoms such as a feeling of distress behind the sternum, pain, back pain, or palpitations.
Diagnosis
The diagnosis of a hiatal hernia is usually made to patients by taking a barium upper gastrointestinal tract X-ray or by endoscopy. In patients with complaints that suggest a hiatal hernia, your doctor will choose one of these diagnostic methods that is appropriate.
Treatment
Treatment for hiatal hernia usually begins when the signs of the disease appear on the ota. Since the anatomical structure is impaired, there is no medical treatment (drug therapy) that will completely correct this disease. In the treatment, it is recommended to raise the bedside table, not to eat for at least 3-4 hours before bedtime, and medications that suppress stomach acid secretion are used (see Treatment of gastroesophageal reflux disease). Smoking, alcohol, fatty foods, excessive coffee and dark tea consumption should be stopped, excess weight should be given. December and frequent intervals of nutrition and the type of exercises that increase intra-abdominal pressure may be beneficial to avoid preference. Wearing a tight belt or corset makes it easier for symptoms to appear.
Surgical treatment:
The definitive and permanent treatment for hiatal hernia is purulent therapy. During surgical treatment, the loosened and enlarged difram slit is narrowed by sewing, and at the same time, the stomach is given a shape similar to an inkwell (Nissen fundoplication). Nowadays, laparoscopic surgery is preferred in many centers. Surgical treatment should be applied in cases that are well evaluated and have been shown to really need surgical treatment. Otherwise, side effects may occur that may disturb the patient after surgery and make him miss the preoperative period.
For this reason, surgical treatment should be applied only in hiatal hernias that do not respond to drug therapy, after the necessary examinations have been performed.. According to radiological studies, hiatal hernia, the incidence of which increases with age, is observed in approximately 10% of adults (3-20%). almost half of people over the age of 60 have a hiatal hernia, which can be of varying degrees. Only about 1/4 of adults with a hiatal hernia complain of a burning sensation in the chest or the arrival of stomach contents into the mouth (gastroesophageal reflux).
A dome-shaped compartment in the November muscle structure called the midriff separates our lungs from the abdominal area. When a person takes a deep breath, the midriff contracts and becomes flat. By doing this, it allows the lungs to fill with air. A small opening on the left side of the diaphragm (hiatus & slit) allows the esophagus to come from the chest cavity into the abdominal cavity and unite with the stomach. This opening, called hiatus, is small and surrounds the esophagus. The stomach is located under the midriff.