DIAPHRAGMATIC HERNIA

A diaphragmatic hernia results when part of the stomach or intestine protrudes into the chest cavity through a defect in the diaphragm.

A hiatus hernia (hiatal hernia) is a particular variant of this type, which forms at the opening in the diaphragm where the esophagus (food pipe) joins the stomach. Part of the stomach herniates or pushes through this opening into the chest causing a hiatal hernia.

Most small hiatal hernias are discovered when checking for another condition. On the other hand, a large hiatal hernia can lead to heartburn, belching, chest pain and nausea as it can allow food and acid to go back up into the esophagus. In rare cases, the herniated part of the stomach that protrudes into the chest may become twisted (strangulated) or have its blood supply cut off, leading to severe chest pain, difficulty in swallowing or obstruction of esophagus.

TREATMENT

Small hernias usually don't require any treatment. For larger hernias, certain lifestyle changes may lead to improvement in condition - like elevating the head of the bed and avoiding lying down directly after meals, losing weight if overweight or obese, etc. Where hernia symptoms are severe and chronic acid reflux is involved, surgery is sometimes recommended, as chronic reflux can severely injure the esophagus and even lead to esophageal cancer.

The surgical procedure used is called Nissen fundoplication. In fundoplication, the gastric fundus (upper part) of the stomach is wrapped, or plicated, around the inferior part of the esophagus, preventing herniation of the stomach through the hiatus in the diaphragm and the reflux of gastric acid. In some cases, this is done using a single incision in your chest wall (thoracotomy) or abdomen (laparotomy). But today, the procedure is now commonly performed laparoscopically. Laparoscopic surgery generally causes less pain and scarring and requires a shorter hospital stay than does thoracotomy or laparotomy.

Note: A congenital diaphragmatic hernia is a distinct problem, occurring in up to 1 in 2000 births, and requiring pediatric surgery. Intestinal organs may herniate through several parts of the diaphragm, posterolateral (in Bochdalek's triangle, resulting in Bochdalek's hernia), or anteromedial-retrosternal (in the cleft of Larrey/Morgagni's foramen, resulting in Morgagni-Larrey hernia, or Morgagni's hernia).

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