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.
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.
Healthy transition from the stomach to the esophagus. The diaphragm surrounds this junction © bilderzwerg | AdobeStock
In principle, three different forms of diaphragmatic hernia can be distinguished:
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.
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.
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
In addition, abdominal surgery can also promote the development of a hiatal hernia.
Heartburn is a symptom of a hiatal hernia © onephoto | AdobeStock
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
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.
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
Doctors can look for signs of a hiatal hernia during an esophagoscopy © romaset | AdobeStock
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:
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.
