Hiatal hernia: how to recognize it and how to treat it

Written by: Prof. Andrea Valeri
Edited by: Top Doctors®

Hiatal hernia is a pathology affecting the stomach whose causes are not entirely known. This is one factor that makes such a disease difficult to diagnose, in addition to being often asymptomatic. The Prof speaks of it. Andrea Valeri, expert in General Surgery in Florence

What is hiatal hernia?

Hiatal hernia means the intrathoracic dislocation of a portion of the stomach through the esophageal hiatus of the diaphragm. We recognize two types of hiatal hernia:

  • Hiatal slipping hernia: it is characterized by the fact that the esophageal hiatus generally undergoes an enlargement and the esophageal membrane is looser, thus provoking the recovery of the cardia and part of the stomach in the thoracic cavity:
  • Paraesophageal or rotation hiatal hernia: it is characterized by the presence of a defect or an area of ​​lower resistance at the level of the brake-esophageal membrane that generally causes a gastric fund herniation.

The etiology of this pathology is unknown: congenital, traumatic and iatrogenic factors are usually considered as possible causes. Another pathogenetic hypothesis considers this pathology, whose frequency is higher in the western world, as a typical phenomenon of western civilization associated with a poor slag diet.

What are the hiatal hernia sitnomas?

Most patients with hiatal hernia are asymptomatic. On the contrary, this pathology sometimes manifests itself with pyrosis or with anginoid thoracic pain syndromes and disturbances of the cardiac rhythm. The clinical manifestation becomes specific when a hiatal gastro-esophageal reflux is associated with hiatal hernia with consequent esophagitis.

How is hiatal hernia treated?

Hiatal slipping hernia, in the absence of a gastroesophageal reflux disease or other complications, does not require any treatment. Different speech must be made for severe hiatal hernia: the characteristic symptoms, such as heartburn and belching, could degenerate and complicate in real digestive difficulties, difficulty breathing and even induce asthma. The only completely resolutive therapy for hiatal hernia is surgery, reserved for a rather small number of patients. Generally, hiatal hernia repair surgery is combined in most cases with an intervention to treat gastroesophageal reflux disease.

*Translated with Google translator. We apologize for any imperfection

By Prof. Andrea Valeri

Prof. Andrea Valeri, specialized in General Surgery and Vascular Surgery, is a national and international medical figure.
Former Director of the Complex Emergency Facility at the Careggi University Hospital, he currently works as a freelancer at Villa Donatello in Sesto Fiorentino and at the Villa Vittoria Surgeries in Florence.

Former Adjunct Professor at the School of Specialization in Gastroenterology and Thoracic Surgery of the Medical Faculty of Florence, he is Past President of the Italian Society of Endoscopic Surgery and former Director of the ACOI Special School of Endocrine Surgery.

Prof. Valeri has carried out numerous training and specialization courses in Italy and abroad, which have led him to be considered a top specialist in his field. He was among the first in Italy to perform laparoscopic adrenalectomy and splenectomy.

Finally he is the author of numerous indexed scientific publications, of a multimedia CD-ROM on "Laparotomy and laparoscopic left hemicolectomy" and of a monograph entitled "The tumors of the adrenal gland".

*Translated with Google translator. We apologize for any imperfection

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