Diaphragmatic hernia: Information & diaphragmatic hernia specialists

A hiatal hernia is when parts of the stomach protrude through an opening in the diaphragm into the chest cavity. Symptoms do not always occur, but in many cases surgery is necessary.

Here you will find further information as well as selected diaphragmatic hernia specialists and centers.

ICD codes for this diseases: K44, K45, K46

Recommended specialists

Brief overview:

  • What is a diaphragmatic hernia? If parts of the stomach move from the abdominal cavity through an opening for the oesophagus in the diaphragm into the chest cavity, this is known as a diaphragmatic hernia.
  • Types: There are three types of diaphragmatic hernia, which differ in terms of which parts of the stomach pass through the diaphragm. They have different effects.
  • Frequency: Men are affected more frequently, from the age of 50 about twice as often as women. The probability of developing a hiatal hernia increases with age.
  • Causes: A hiatal hernia can be congenital or acquired. Those affected usually suffer from weak connective tissue. In combination with other risk factors, such as severe obesity, pregnancy and advanced age, the risk increases.
  • Symptoms: Symptoms do not always appear and the symptoms depend on the type of hiatal hernia. Symptoms may include heartburn, anemia, bloating and others.
  • Diagnosis: The doctor can only make a reliable diagnosis using imaging procedures (gastrointestinal passage, esophagoscopy, MRI, CT).
  • Treatment: Mild symptoms are treated with medication. Surgery is required for more severe symptoms or functional limitations.

Article overview

A hiatal hernia is when parts of the stomach move through a gap in the diaphragm into the chest cavity. The diaphragm separates the abdominal cavity from the chest cavity. This is why a hiatal hernia is also known as a diaphragmatic hernia.

A diaphragmatic hernia is not a hernia in the true sense of the word, such as an inguinal hernia. The gap in the diaphragm, the so-called oesophageal hiatus, is a necessary anatomical structure and not a weak point in the tissue as in other hernias.

The esophagus leads from the pharynx through the esophageal hiatus to the stomach in the abdomen. Under certain circumstances, parts of the stomach can pass through this gap into the chest cavity.

A hiatal hernia does not protrude from the inside of the body to the outside, as is the case with an inguinal hernia or umbilical hernia. It is therefore classified as an internal hernia.

Anatomie von Magen und Speiseröhre
Healthy transition from the stomach to the esophagus. The diaphragm surrounds this junction © bilderzwerg | AdobeStock

Types of diaphragmatic hernia

In principle, three different forms of diaphragmatic hernia can be distinguished:

  • the cardiofundal malposition,
  • the axial hernia (sliding hernia) and
  • paraesophageal hiatal hernia.

Cardiofundal malposition is the mildest form of hiatal hernia. In this case, the ligamentous apparatus that attaches the stomach to the diaphragm has loosened. As a result, the esophagus opens into the stomach at a more obtuse angle than the so-called esophagogastric angle or His angle. Symptoms only rarely arise due to the cardiofundal malposition.

In paraesophageal hiatal hernia, parts of the stomach are pushed next to the esophagus through the esophageal hiatus into the chest cavity from below. This can lead to a narrowing of the stomach and, in extreme cases, to an upside-down stomach. In an upside-down stomach, the entire stomach lies above the diaphragm.

The axial hernia is also known as a sliding hernia. As with paraesophageal hernia, the upper part of the stomach slides upwards through the esophageal hiatus into the chest cavity. This also disrupts the function of the esophageal sphincter. In this case, stomach contents can flow back into the esophagus. This is also known as reflux disease. The axial hernia is the most common form of hiatal hernia, accounting for 90 percent of cases.

Frequency of the hiatal hernia

The hiatal hernia is the most common form of internal hernia. Men are affected more frequently than women. In people over the age of fifty, around twice as many men as women suffer a hiatal hernia.

Overall, the likelihood of suffering a hiatal hernia increases with age.

Causes and risk factors of a hiatal hernia

A hiatal hernia can be either congenital or acquired.

An acquired diaphragmatic hernia is caused by an enlargement or dilation of the esophageal hiatus. The cause is usually a general weakness in the connective tissue of the diaphragm in conjunction with a prolonged increase in pressure in the abdominal cavity.

For this reason, people who are particularly overweight have an increased risk of suffering a hiatal hernia.

Other risk factors for the development of a hiatal hernia are

  • pregnancy,
  • advanced age and
  • the male sex.

In addition, abdominal surgery can also promote the development of a hiatal hernia.

Mann mit Sodbrennen
Heartburn is a symptom of a hiatal hernia © onephoto | AdobeStock

Symptoms of a hiatal hernia

A hiatal hernia may or may not cause symptoms. The nature of the symptoms depends on the type of hiatal hernia.

Possible symptoms that can occur with a hiatal hernia include

  • Heartburn,
  • Anemia,
  • a feeling of fullness,
  • belching,
  • difficulty swallowing and
  • apnea.

If parts of the stomach are trapped in the gap in the diaphragm, stomach pain or pain in the upper abdomen or chest may also occur.

Diagnosis of the diaphragmatic hernia

To diagnose a diaphragmatic hernia, the doctor will first ask the patient about their symptoms as part of a medical history interview. If the patient reports symptoms such as heartburn, this may indicate the presence of reflux disease and a hiatal hernia.

However, a clear diagnosis of a hiatal hernia can only be made using imaging examinations. These include, for example

MagenspiegelungDoctors can look for signs of a hiatal hernia during an esophagoscopy © romaset | AdobeStock

Treatment of the hiatal hernia

Mild symptoms such as heartburn can usually be treated with medication initially.

However, a hiatal hernia can also impair vital functions such as breathing. There is also a risk of organ damage. In these cases, a hiatal hernia operation must be performed as part of hernia surgery.

Various surgical options are available for this procedure:

  • Fundoplication (either according to Nissen and Rosetti or according to Toupet),
  • gastropexy or fundopexy and
  • hiatoplasty.

In fundoplication, a sleeve is formed from parts of the stomach and placed around the lower part of the oesophagus.

In a gastropexy (fundopexy), the stomach is moved into its normal position and sutured to the anterior abdominal wall.

In a hiatoplasty, the gap in the diaphragm (oesophageal hiatus) is sutured tighter.

Whatsapp Facebook Instagram YouTube E-Mail Print