Diaphragmatic hernia
A diaphragmatic hernia occurs in the diaphragm, where the esophagus joins the stomach. This is a pathological condition in which an anatomical element normally located in the abdominal cavity (a part of the stomach) passes abnormally through a normal opening in the diaphragm into the thoracic cavity
Diaphragmatic hernia is the most important cause of Gastroesophageal reflux disease. Consequently, the symptoms of Diaphragmatic hernia are the same as those of Gastroesophageal reflux disease.
Several factors are responsible for the creation of diaphragmatic hernia, such as:
- Inheritance
- Obesity
- Pregnancy
- Weight lifting
- Increased intra-abdominal pressure
- Chronic constipation
- Aging and weakening of muscles and ligaments
- Smoking
- Alcohol
The complications of Diaphragmatic hernia depend on the progression of the disease it causes, namely Gastroesophageal reflux disease.
Reflux and chronic exposure of the oesophagus to the acidic contents of the stomach mainly causes two serious conditions:
Α) Esophagitis. It can range from mild erosions of the mucosa of the esophagus (1st degree esophagitis) to Ulceration, Fibrosis and strictures of the organ (4th degree esophagitis).
B) Barrett’s oesophagus. This is a metaplasia of the normal esophageal mucosa into intestinal epithelium. Barrett’s Esophagus is considered a precancerous stage for Esophageal Adenocarcinoma.
In case of advanced oesophagitis, where there is a risk to the patient’s health, and when the quality of life is impaired due to severe reflux, surgical treatment is mandatory.
These procedures are called antipalindromic and aim to create a valve mechanism in the area of the gastroesophageal junction to correct the reflux and free the patient from discomfort and complications. Laparoscopic Nissen or Toupet’s Tholoplasty is the most common antipalindromic procedure for the surgical correction of diaphragmatic hernia.
