the question
I am a man age 55 years and I carry almost 15 kg overweight. I have recently had a high frequency of heartburn and an acid taste in my throat. The doctor has diagnosed a hernia in the diaphragm. Does this require surgery?
The answer
Hernia is the pressure of an organ through a hole in the muscular wall of the cavity that protects it. In the case of a diaphragmatic hernia, part of the stomach is pressed through the hole where the esophagus and stomach meet.
The most common cause of diaphragmatic hernia is increased pressure on the abdominal cavity. Pressure can come from coughing, vomiting, pressure during defecation, heavy lifting, or physical stress. Pregnancy, excess weight or fluid accumulation in the abdominal cavity can also cause diaphragmatic hernia.
Diaphragmatic hernia can occur at any age and in both sexes, although it often occurs in middle age. In fact, most people over the age of 50, intact except for this problem, suffer from small hernias in the diaphragm.
Most people with diaphragmatic hernia do not feel any symptoms. In some people, acid and digestive juices come out of the stomach into the esophagus (reflux). This command causes the following problems:
Heartburn
A bitter or acidic taste in the deep throat
Bloating and belching
Discomfort or pain in the stomach or esophagus
Vomiting
Most hiatal hernias do not cause problems and rarely need treatment. Successful treatment of diaphragmatic hernia usually involves treating Reflux reflux symptoms, caused by excessive pressure in the abdominal cavity.
Treatment includes:
Make lifestyle changes, such as:
• Reduce weight, if you are overweight, maintain a healthy diet.
• Maintain a reasonable approach to eating, such as eating small to medium meals; reducing the intake of fatty foods, acidic foods (such as tomatoes, citrus and fruit juices), caffeinated foods and alcoholic beverages.
• Eat meals three to four hours before bedtime, avoid snacks before bedtime.
• Raise the head position in your bed by 15 cm (this helps the force of gravity to preserve the contents of the stomach).
• stop smoking.
• Avoid tight clothing that presses the abdominal area.
• Take medications, such as antacids, H2 blockers, or PPIs. Be aware: If you are taking over-the-counter medications, do not feel better, or have taken this medicine for more than two weeks, talk to your doctor. It may prescribe a stronger medicine.
If medications and lifestyle changes are not effective in treating your symptoms, diagnostic tests may be required to determine if surgical intervention is required to correct the problem or symptoms using these methods.
People with diaphragmatic hernias, as well as chronic and severe reflux may need surgery to correct the problem if their symptoms do not improve with these treatments. Surgery may also be required to minimize hernias if there is a risk of stenosis or strangulation (by cutting off blood supply). During surgery, the reflux is corrected by returning the diaphragmatic hernia to the inside of the abdomen, creating an improved valve mechanism at the bottom of the esophagus. The surgeon wraps the upper part of the stomach (labeled fundus) around the bottom of the esophagus. This forms a narrower passage so that food cannot bounce back into the esophagus.
Diaphragm surgery can be performed either by opening the abdominal cavity or by Laparoscopy laparoscopy. During laparoscopic surgery, five or six small incisions (5-10 mm long) are incised in the abdomen. Laparoscopy and surgical instruments are inserted through these incisions. The surgeon uses a laparoscope for guidance, where images of the internal organs are broadcast on the screen. Features of endoscopic surgery include smaller incisions, less risk of infection, less pain and scarring, and faster healing.
by Dr Mahad Shah
Ms Productions
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