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gastro ./ bariatric surgery

Prevention, Causes And Definition Of Hiatus Hernia
By Groshan Fabiola
Hiatus hernia is due to the upper part of the stomach getting into the chest cavity because of a weakened esophageal hiatus. As a result of an often undetected hiatal hernia, many people suffer from esophageal reflux.

According to scientific studies, the diaphragmatic opening where the esophagus connects to the stomach, acts as an additional sphincter and together with the lower esophagus sphincter prevents the stomach content from backing up into the esophagus. When a hiatus hernia occurs, the sphincter function is weakened and the esophageal reflux disease manifests itself.

The esophageal reflux is in fact manifested by retention of the acid gastric contents of the stomach in the superior part of the stomach making the reflux into the esophagus possible. When the actual hiatus hernia is present and acid contents get into the esophageal tube, permanent lesions of the esophageal mucosa appear leading to major symptoms of heartburn, chest pain and a persistent sensitivity to food. Hiatal hernia sufferers experience high grade heartburns after heavy meals and are forced to eat more often and smaller quantities in order to prevent the esophageal reflux.

According to a clinical classification, there are two major types of hiatus hernia:
In case of a sliding hiatal hernia both esophageal junction and upper part of the stomach get into the chest cavity due to the weakened muscular hiatuses, meaning the lower esophageal sphincter and the diaphragmatic hiatus.

The junction connecting the esophagus to the stomach can remain permanently into the chest cavity or only slide up during the food or liquid swallowing process. The actual explanation is the functional changes

that take place during swallowing when the esophagus shortens due to its contraction and pulls on the stomach’s upper part.
When the swallowing is completed, the esophageal junction falls back down into the abdomen. The sliding type occupies about 90% of all cases of hiatus hernia.

The second type is the Para esophageal hernia and occurs when the esophageal junction remains in its normal physiological position but the upper part of the stomach slides back into the chest cavity beside the esophagus. In this case, the hiatus hernia remains permanently inside the chest and can lead to major and dangerous complications. The most frequent complications of the Para esophageal hernia are incarceration and strangulation.

Incarceration is the numb and squeeze of the hernia. Strangulation is the evolution complication of an untreated hernia incarceration. The blood supply is interrupted and the tissues involved begin to die. In this case, immediate surgical intervention is necessary.

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