Hiatal Hernia (Stomach Hernia) : Definition, Causes, Types, Symptoms, Diagnosis, Radiology, Treatment, Surgery, Diet, & PPT
Definition
- Hiatus hernia is a condition in which the upper part of stomach pushes up through the diaphragm (hiatus) into the chest cavity.
- It is the most common type of diaphragmatic hernia.
- Common in elderly.
Types
1. Sliding (axial) hiatus hernia
- Stomach (cardia) and the section of the esophagus that joins the stomach migrates back and forth between the
posterior mediastinum and peritoneal cavity. - More common type (85%).
- It is commonly associated with GORD.
2. Rolling (paraesophageal) hiatus hernia
- Less common type (10-12%)
- More cause for concern because stomach can become strangled, or have its blood supply shut off.
- Esophagus and stomach stay in their normal locations, but herniation of stomach fundus, usually towards left side.
3. Mixed type
Saint’s triad
- Hiatus hernia
- Diverticulosis
- Gallstone
Clinical Features
- Abdominal pain
- Chest pain
- Hiccough,
- Early satiety
- Regurgitation
- Postprandial bloating
- Cardiac abnormality (arrhythmia)
- Dysphagia
- Dyspnoea
40% presents as acute features with perforation/ gangrene/bleeding.
Complications
- Gangrene of stomach
- Perforation into the mediastinum and/or peritoneum
- Gastric volvulus
Investigations
1. Barium meal
- Investigation of choice
2. Plain X-ray
- lateral & PA erect view
Findings
- Rolling type: Retrocardiac air fluid level
3. ECG
4. 3D CT scan
Treatment
Always Surgical
1. Nissen fundoplication
- Performed laparoscopically
- Floppy 360° complete wrap
- Most common complication: Gas bloat syndrome
2. Partial wrap
- 270° anterior wrap by thoracotomy (Belsey Mark IV Fundoplication)
- 180°- 270° posterior wrap (Toupet Fundoplication)
- 180°- 270° anterior wrap (Dor Fundoplication)
- <180° anterior wrap by laproscopy (Watson Fundoplication)
3. Allison repair
- Make the hiatus hernia narrow by approximating the crus of diaphragm.
4. Hills repair
- Angle of his is made acute.
5. Collis gastroplasty
6. Gastrectomy if f it is gangrenous
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