Diaphragmatic Hernia – Acid Reflux

INTRODUCTION-DEFINITION

It is a common condition of the digestive system. It is a movement (permanent or casual) of the stomach into the chest of the diaphragm, hence the term hernia. The cause of the phenomenon can be the weight increase, the increase of the intra-abdominal pressure (pregnancy), a heavy physical activity or just be a congenital deficiency of the mechanisms that keep dammed the stomach through the abdomen.

SYMPTOMS

The symptoms of the hernia are symptoms of gastroesophageal reflux disease (GERD) that are due to the passage of gastric contents into the esophagus. Usually it is the chest burning sensation (heartburn), belching (burping), but also less typical symptoms such as pain on swallowing, coughing usually at night due to mikro aspirations, hoarseness in the voice, anemia (hematocrit drop), unpleasant taste in the mouth, etc.

 

There are three necessary tests for the diagnosis and staging of gastroesophageal reflux disease (GERD)

i.            The gastroscopy, will describe the size and the location of the hernia, will show the severity of esophagitis, and allow the exclusion of the existence of the Barrett esophagus, which is a precancerous condition, due to chronically neglected regressions and lies in the presence of cells of the small intestine and stomach into the lower esophagus.

ii.            The manometry, which measures the mobility of the esophagus and the adequacy of the lower sphincter and general the state of the locomotor synchronization in the upper digestive tract.

iii.            The PHmetry which measures the amount of reflux of acidic stomach contents into the esophagus (because of the hydrochloric acid).

SURGERY

The surgery is performed under general anesthesia and lasts from 30’ to 1 hour. It is made laparoscopically and does not require any installation or removal of foreign material portion of the instrument. It is entirely benign and lies to in the narrowing diaphragm, so that the stomach can no longer pass over the chest and the construction of the anti- reflux valve, which is created by placing the stomach itself as "scarf" around the esophagus.

The surgery is called fundoplication according NISSEN, with different variations depending on the case (TOUPET, DOR, LORTAT-JACOB).

 

After the surgery and the return to the room, the patient will get up and eat the same night. The hospital stay is 24-48 hours. For 15 days the patient will follow specific dietary instructions and taking medications for the treatment of esophagitis. After this period do not require special attention to diet or treatment with gastroprotective, like Losec, Nexium, Pariet, Controloc, etc.

Later, a little difficulty in swallowing (dysphagia) will completely disappearance and life will become completely normal without medication.