Definition of hiatus hernia
Hiatus hernia is defined as a prolapse of the upper stomach migrates into the thorax through the esophageal hiatus of the diaphragm, the hiatus henia usually determines the existence of GR by anatomic or functional defect containment mechanism esophageal gastric transition.
GR (Gastroesophageal Reflux) is related by an incompetent lower esophageal sphincter or ineffective esophageal clearance, ie failure of the defense mechanisms of the esophageal mucosa against the aggressiveness of stomach acid. There are two types of hiatus hernia, the sliding and paraesophageal, the first is associated with symptomatic GR.
Sustained exposure of the esophagus to the stomach produces acid esophagitis, ulcerations that can produce bleeding or perforation, stenosis and Barrett's metaplasia the call.
Questions and answers of hiatus hernia.
How are clinically manifested in GR?
When there is inflammation of the esophagus most annoying symptoms are burning, which is the burning sensation behind the breastbone and rises to the throat, being more intense when lying down or bending over, another symptom is pain when moving food to the stomach. Other symptoms may include: pseudolor heart, nausea, cough, asthma.
A simple chest radiograph can consistently find a mass of soft tissue in the posterior mediastinum, with a fluid level in the case of large hernias. Studies with barium contrast media are more defining discovering the existence of gastric folds above the diaphragm. The esophagogram is also useful for the diagnosis of short esophagus.
Endoscopy detects the location of the transition line eofogogastrica, located within 2 cm above the diaphragmatic hiatus, so that a greater distance between these structures indicates the presence of a hiatus hernia. The endoscopy needed to understand the degree of esophagitis.
Other studies such as pH monitoring and manometry are essential for the diagnosis of GR associated with hiatal hernia. Manometry determines the location, size and pressure of the lower esophageal sphincter (LES) and also to rule out esophageal motility disorders prior to surgery .
Medical treatment for hiatus hernia.
The symptoms are susceptible to medical treatment, in relation to GR. The therapeutic method includes changes in lifestyle, use of drugs suppressing stomach acid secretion. But we can consider that symptomatic relapse is common after withdrawal of medical treatment, which requires the repetition of the medication for long periods of time, and the possible complications, do consider giving medication to go to surgery.
Laparoscopic surgey hiatus hernia
How do you operate the hiatus hernia?
There are many surgical techniques, but the most used for its efficiency in the operation Nissen valvuloplasty or plastic, can and should do after laparoscopically, with equal or greater safety for the patient than conventional surgery, with the advantage that the patient has a postoperative comfort that makes it easy to go home to after 24 hours after the operation, ie it is discharged from the clinic.
What is the technique of Nissen?
Involves the invagination of the esophagus in a sleeve of the gastric wall obtained from the upper portion of the stomach. The operation is done under general anesthesia, using five trocars placed in the upper abdomen (above the navel). The onset is the dissection of the rear face of the esophagus, through the identification of the pillars of the diaphragm. The mobilization of the fundus of the stomach is made possible by the short section of vessels gastrosplenic omentum. The operation ends with the closing of the pillars of the diaphragm and the bottom step of the stomach behind the esophagus to allow the construction of the check valve with fixing points.
Laparoscopic surgery postoperative.
During first postoperative day the patient remains fluid resuscitation with which left the operating room the next day you are allowed to drink and pasty foods. On the second day after operation, barium study is performed (with slurry) of the esophagus, stomach and duodenum, to assess the status of the valve relative to its position and function. The normality of this exploration allows the patient to be discharged from hospital.