Materiały źródłowe

• #1 Hiatal Hernia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562200/

  A hiatal hernia is a common condition characterized by the abnormal protrusion of the upper part of the stomach or other internal organs through the diaphragm’s hiatus. The development of a hiatal hernia is multifactorial, with contributing factors including congenital anatomical defects, increased intraabdominal pressure (as seen in obesity, pregnancy, and chronic coughing), and age-related changes in the diaphragm’s muscle tone. […] Hiatal hernias may be congenital or acquired. The condition’s prevalence is increased among older people. Muscle weakness due to age-related loss of flexibility and elasticity is believed to be a predisposing factor to the development of a hiatal hernia. The hernia may prevent the upper part of the stomach from returning to its natural position below the diaphragm during swallowing. Other predisposing factors have been identified, such as elevated intraabdominal pressure, which typically arises from obesity, pregnancy, chronic constipation, and chronic obstructive pulmonary disease (COPD). Trauma, age, previous surgeries, and genetics also play a role in the development of a hiatal hernia.

• #2 The Pathogenesis of Hiatal Hernia | CoLab

  https://colab.ws/articles/10.1177%2F26345161221083020

  Hiatal hernia is a common malady and an important contributor to the pathophysiology of gastroesophageal reflux disease (GERD). Hiatal herniation is thought to result from any of several causes including transdiaphragmatic pressure gradients; congenital or acquired abnormalities in the cellular structure, biochemical composition, or geometry of the hiatus; or esophageal shortening due to fibrosis. […] Since no single theory explains the development of a hiatal hernia in all cases, or the reasons behind progression of some and not others, the pathogenesis of hiatal herniation likely is multifactorial and varies between individuals. A comprehension of the factors leading to hiatal hernia formation is important to their prevention and correction as well as to an understanding of the pathogenesis of GERD.

• #3 Hiatal hernia – epidemiology, pathogenesis, diagnostic • Postępy Nauk Medycznych 5/2018 • Czytelnia Medyczna BORGIS

  https://www.czytelniamedyczna.pl/6473,hiatal-hernia-epidemiology-pathogenesis-diagnostic.html

  Hiatal hernia is a common pathology in the field of surgery, the frequency of occurrence increases along with age. It is caused by an increase in intra-abdominal pressure and weakening of the diaphragm crura tissues. […] Epidemiology of hiatal hernia occurrence has been analyzed along with their pathogenesis, symptomatology, the most frequently used diagnostic methods and therapeutic possibilities. […] Hiatal hernia may be congenital or acquired. Among acquired hiatal hernias, traumatic and nontraumatic are distinguished. The most common types of hernia are acquired in non-traumatic manner. Nontraumatic acquired hernias are divided into four subtypes: sliding (type I) and paraoesophageal (type II). Mixed type with coexisting features of sliding and paraoesophageal hernia are also observed (type III). IV type of hiatal hernia is connected with short esophagus. Sliding hiatal hernia is most common type of hiatal hernia. It occurs when the gastro-esophageal junction, along with the part of the stomach, migrates to the mediastinum through the esophagus.

• #4 Causes of unsuccessful surgical treatment of hiatal hernia – Bechvaya – Pediatrician (St. Petersburg)

  https://journals.eco-vector.com/pediatr/article/view/34604

  Hiatal hernia (hiatus hernia) is condition where abdominal organs are displaced through the hiatal opening into the chest. […] The main cause of displacement of abdominal organs into the chest is the mechanical weakness of the esophagogastric membrane due to the congenital or involutive inferiority of the connective tissue (elastin deficiency). Stretching of the esophagogastric membrane leads to the displacement of one or more organs of the abdominal cavity into the mediastinum. […] The ineffectiveness of drug therapy for gastroesophageal reflux or the development of its complications (ulcers, strictures, Barrett syndrome, bronchial asthma, chronic laryngitis, recurrent otitis media, etc.) is considered an indication for surgical treatment for axial (type I) hiatal hernias. […] Type IIIV hiatal hernias may be accompanied with life-threatening conditions, such as acute gastric or intestinal obstruction, ischemia, and necrosis located in the hernial sac of organs, and considered indications for surgical treatment, regardless of the presence or absence of clinical symptoms upon detection.

• #5 What Is the Main Cause of Hiatal Hernia? – Dr. ABTIN KHOSRAVI, MD

  https://ocroboticsurgery.com/what-is-the-main-cause-of-hiatal-hernia/

  A hiatal hernia is the result of the upper portion of the stomach or organs in the upper abdominal cavity pushes through a weakened area in the diaphragm into the chest. […] There is no singular cause for hiatal hernias. However, certain conditions make the development of one more likely. Abdominal muscle weakness is associated with most hiatal hernia cases. Increased pressure and force on the connective tissues supporting the musculature wall of the abdominal cavity is the primary factor in hiatal hernias. […] The muscles and supportive issues that keep the organs in place behind the abdominal cavity become weaker with age and weight. Hiatal hernias can also be caused by acid reflux, coughing, straining during bowel movements, vomiting, poor lifting mechanics, and muscle strain and injury. […] Keep in mind that hiatal hernias can also develop from other conditions, such as pregnancy, congenital defects, obesity, fluid retention.

• #6 Hiatal hernia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hiatal-hernia/symptoms-causes/syc-20373379

  A hiatal hernia occurs when the upper part of the stomach bulges through the diaphragm into the chest cavity. […] A hiatal hernia happens when the upper part of the stomach bulges through the large muscle that separates the abdomen and the chest. The muscle is called the diaphragm. […] The diaphragm has a small opening called a hiatus. The tube used for swallowing food, called the esophagus, passes through the hiatus before connecting to the stomach. In a hiatal hernia, the stomach pushes up through that opening and into the chest. […] A hiatal hernia occurs when weakened muscle tissue allows your stomach to bulge up through your diaphragm. It’s not always clear why this happens. But a hiatal hernia might be caused by: Age-related changes in your diaphragm. Injury to the area, for example, after trauma or certain types of surgery. Being born with a very large hiatus. Constant and intense pressure on the surrounding muscles. This can happen while coughing, vomiting, straining during a bowel movement, exercising or lifting heavy objects.

• #7 Hiatus Hernias | Sliding, Rolling | Treatment – RefluxUK

  https://refluxuk.com/diagnosis/hiatus-hernia

  Gastroesophageal Reflux Disease (GERD) can be either primary or secondary. […] Hiatus hernias are probably the main cause of GORD as they cause failure of the LOS. […] A hiatus hernia occurs when the soft tissues around the crura and the muscles themselves become weak. Research has shown that there are often identifiable biochemical and associated genetic abnormalities in the tissues around the crura that cause them to deteriorate. […] As a consequence of these weaknesses the usual connections between the crura and the oesophagus decay and in due course the gap between the crura, the hiatus, enlarges. […] Once the sling fibres of the oesophagus are no longer augmented by the crura, the LOS almost always becomes weak and incompetent. […] Without repair it wont work properly. This is supported by published evidence from clinical trials that has shown that once patients develop regurgitation, high dose antacids including PPIs will control symptoms in only about 10% of patients whereas surgery is effective in 90%. […] In the presence of a hiatus hernia we would advise that LINX or fundoplication is more likely to achieve a good result in terms of reduced reflux symptoms than other interventions.

• #8 All You Need to Know About Hiatal Hernias – GI Surgical

  https://www.gisurgical.com/blog/all-you-need-to-know-about-hiatal-hernias/

  A hiatal hernia is a medical condition that occurs when the upper part of your stomach bulges through your diaphragm into your chest cavity. […] It is the progressive laxity of this hole and widening that allows the stomach to migrate into the chest. […] The exact cause of hiatal hernia is unknown. However increased pressure in the abdominal cavity leads to pushing intestinal contents outside of the abdomen. This coupled with changes in the connective tissue protecting against herniation likely leads to hernia formation. […] If medications no longer control your symptoms, or worse, you have developed acid reflux damage (esophagitis or Barrett’s esophagus) then hiatal hernia repair is recommended. […] Hiatal hernia repair is straight forward and includes repairing the gap in the diaphragm after returning the stomach to the abdomen.

• #9 Clinical Significance of Hiatal Hernia

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=284&vmd=Full

  The relationship between hiatal hernias and gastroesophageal reflux disease (GERD) has been greatly debated over the past decades, with the importance of hiatal hernias first being overemphasized and then later being nearly neglected. It is now understood that both the anatomical (hiatal hernia) and the physiological (lower esophageal sphincter) features of the gastroesophageal junction play important, but independent, roles in the pathogenesis of GERD, constituting the widely accepted „two-sphincter hypothesis.” […] The gastroesophageal junction becomes incompetent and esophageal acid clearance is compromised in patients with hiatal hernia, which facilitates the development of GERD. Of the different types of hiatal hernias (types I, II, III, and IV), type I (sliding) hiatal hernias are closely associated with GERD.

• #10 The relationship of hiatal hernia and gastroesophageal reflux symptoms—two-sphincter hypothesis: a review – Andrews – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/5841/html

  The anatomy and physiology of the GEJ, as it relates to the development and progression of GERD, has been the primary focus of much research beginning in the 1950s. […] The Two-Sphincter Hypothesis is a concept that incorporates both the anatomy and the physiology of the GEJ to form the reflux barrier. […] The intrinsic sphincter is created by the LES and the angle of His. At rest these components, when intact, create the baseline anatomical barrier for reflux via radial compression and the acute insertion angle of the esophagus into the stomach. […] While the clasps and sling fibers give evidence of a muscular sphincter, it is the length of the LES and the subsequent pressure created by that length that allows the tonic contraction which contributes to the reflux barrier. […] In patients with a high-pressure zone (HPZ) of less than 5 mmHg and an abdominal esophageal length of less than 1 cm, the LES was grossly incompetent and thus significantly more at risk for GERD.

• #11 The relationship of hiatal hernia and gastroesophageal reflux symptoms—two-sphincter hypothesis: a review – Andrews – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/5841/html

  The angle of His creates a static anatomical barrier or flap valve at the GEJ to contribute to the barrier protection at rest along with the LES. […] The crural diaphragm represents the canal through which the esophagus travels as is exits the low-pressure thoracic cavity to the higher-pressure abdominal cavity. […] The final component of the reflux barrier and the second part of the extrinsic sphincter is the phrenoesophageal membrane or ligament. […] The presence of GERD and hiatal hernias compared to normal became a model to demonstrate the existence of these sphincters. […] The hiatal hernia group was further sub-divided by size (3.0, 3.05.0, and 5.0 cm). […] The lower resting pressures of the larger hernias represent the loss of the anatomical partnership between the LES and the crural diaphragm.

• #12 Clinical Significance of Hiatal Hernia

  https://www.gutnliver.org/journal/view.html?volume=5&number=3&spage=267

  The relationship between hiatal hernias and gastroesophageal reflux disease (GERD) has been greatly debated over the past decades, with the importance of hiatal hernias first being overemphasized and then later being nearly neglected. […] It is now understood that both the anatomical (hiatal hernia) and the physiological (lower esophageal sphincter) features of the gastroesophageal junction play important, but independent, roles in the pathogenesis of GERD, constituting the widely accepted „two-sphincter hypothesis.” […] However, the gastroesophageal junction becomes incompetent and esophageal acid clearance is compromised in patients with hiatal hernia, which facilitates the development of GERD. […] Of the different types of hiatal hernias (types I, II, III, and IV), type I (sliding) hiatal hernias are closely associated with GERD.

• #13 Clinical Significance of Hiatal Hernia

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=284&vmd=Full

  The mechanism of reflux due to GEJ incompetence can be summed down to three: 1) tLESRs, 2) hypotensive LES, and 3) anatomical defect such as hiatal hernia. […] In hiatal hernia, the LES is displaced proximally, and this leads to spatial separation of the intrinsic LES from the extrinsic compression by the diaphragm, which results in decreased resting LES pressure in proportion to the size of the hiatal hernia. […] The proximal displacement of the LES in hiatal hernia further compromises the competence of the GEJ due to the loss of the intra-abdominal segment of the LES, because the intra-abdominal location of the LES per se is considered to serve as a valve by being exposed to the positive abdominal pressure. […] Many studies have demonstrated that hiatal hernia is closely related to reflux symptoms, reflux esophagitis, Barrett’s esophagus and esophageal adenocarcinoma.

• #14 Hiatal Hernia: Causes, Symptoms, Diagnosis & Treatment

  https://www.clevelandclinicabudhabi.ae/en/health-hub/health-resource/diseases-and-conditions/hiatal-hernia

  A hiatal hernia occurs when the upper part of the stomach pushes through an opening in the diaphragm and into the chest cavity. […] The most common cause of a hiatal hernia is an increase in pressure in the abdominal cavity. […] Pressure can come from coughing, vomiting, straining during a bowel movement, heavy lifting, or physical strain. […] Pregnancy, obesity, or extra fluid in the abdomen can also lead to a hiatal hernia. […] If the portion of the stomach entering the esophagus is being squeezed so tightly that the blood supply is being cut off, surgery is needed. […] Surgery may also be needed in people with a hiatal hernia who also have severe, long-lasting (chronic) esophageal reflux whose symptoms are not relieved by medical treatments. […] The goal of this surgery is to correct gastroesophageal reflux by creating an improved valve mechanism at the bottom of the esophagus.

• #15 Obesity and its Link to Hiatal Hernias

  https://surgeonadamharris.com/obesity-and-its-link-to-hiatal-hernias/

  Obesity has been identified as a risk factor for hiatal hernia, with studies showing a strong correlation between the two. The prevalence of hiatal hernias is higher in obese individuals compared to those with a normal weight. The increased weight and pressure exerted on the abdomen due to excess fat can contribute to the development and worsening of hiatal hernias. […] Several mechanisms have been proposed to explain the link between obesity and hiatal hernia development. One of the primary factors is the increased abdominal pressure caused by excessive body weight. The heightened pressure can push the stomach upward through the diaphragmatic opening, leading to hiatal hernia formation. Additionally, obesity is associated with changes in pressure within the abdomen, weakening of the lower esophageal sphincter (the ring of muscle that prevents acid reflux), and increased intra-abdominal fat, all of which contribute to hiatal hernia development.

• #16 Diet for Hiatal Hernia Prevention

  https://nutritionfacts.org/video/diet-and-hiatal-hernia/

  Straining at stool over time may force part of the stomach up into the chest, contributing to GERD acid reflux disease. […] Hiatus hernia occurs when part of the stomach is pushed up through the diaphragm into the chest cavity, which makes it easy for acid to reflux up into the esophagus and throat. […] A simple model may help illustrate the mechanism producing upward herniation of the stomach through the hole in the diaphragm, which separates the abdomen from the chest, called the esophageal hiatus. […] When we bear down and strain at stool, its like squeezing our abdomen, and may herniate part of our stomach up. […] Consistent with this concept is the observation that in Africans the lower esophageal sphincter is entirely sub-diaphragmatic, whereas it usually straddles the diaphragm in Westerners, and is above the diaphragm in the presence of hiatus hernia.

• #17 Hiatal Hernia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562200/

  The incidence of hiatal hernias increases with age. Approximately 55% to 60% of individuals older than 50 have a hiatal hernia. However, only about 9% have symptoms, with the manifestations depending on the type and competence of the LES. The vast majority of these hernias are type I sliding hiatal hernias. Type II paraesophageal hernias only comprise about 5% of hiatal hernias where the LES remains stationary, but the stomach protrudes above the diaphragm. […] The management of hiatal hernias depends on the type of hernia and the severity of the symptoms. The initial treatment given to a patient presenting with typical GERD symptoms in an outpatient setting includes a double dose of a proton pump inhibitor (PPI), which can be both therapeutic and diagnostic in that persistent symptoms often require a more extensive evaluation.

• #18 Hiatus Hernia – Rolling – Sliding – Management – TeachMeSurgery

  https://teachmesurgery.com/general/gastric/hiatus-hernia/

  A hiatus hernia describes the protrusion of an organ from the abdominal cavity into the thorax through the oesophageal hiatus. This is typically the stomach herniating, although less commonly other structures, such as small bowel, colon, or omentum can herniate through. Other types of diaphragmatic hernia also exist. […] Sliding hernia are frequently associated with gastro-oesophageal reflux disease (GORD). Types II-IV are all forms of paraoesophageal hernias, and have a higher risk of gastric ischaemia or volvulus. […] Age is the main risk factor for developing a hiatus hernia, due to a combination of age-related loss of diaphragmatic tone, increasing intrabdominal pressures (e.g. repetitive coughing), and an increased size of diaphragmatic hiatus. […] Previous oesophageal and stomach surgery also increase the risk of developing hiatus hernia, due to the disruption to the oesophageal hiatus.

• #19 | General Surgeon & Foregut Surgeon located in Lone Tree, CO | Institute of Esophageal and Reflux Surgery

  https://www.iersurgery.com/content/large-hiatal-hernia-paraesophageal-hernia

  Recent studies have shown a collagen defect in the diaphragm in patients with a hiatal hernia. Over time, and as we age, our tissues become weaker, causing a small hernia can become a larger hernia. […] Large or giant hiatal hernias often cause a portion of the stomach to be up in the chest and can result in reflux or other problems including chest pain, food sticking, painful upper abdominal bloating, and the feeling of getting full early or shortness of breath, especially after eating. […] Paraesophageal hernias are one type of large hiatal hernia and occur when the stomach slides up beside the esophagus. […] Symptoms of paraesophageal hernias often include bloating and chest pain. Surgery may be necessary in these situations to prevent loss of the stomach, and occasionally this surgery needs to be done on an emergency basis.

• #20 Hiatus hernias and the Hill classification – Endoscopy Campus

  https://www.endoscopy-campus.com/en/classifications/hiatus-hernias-and-the-hill-classification/

  Herniation of the stomach through the esophageal hiatus into the mediastinum is known as hiatus hernia. It is a frequent incidental finding during gastroscopy. The prevalence of the condition increases with increasing age and when there is raised intra-abdominal pressure (e.g., in obesity or pregnancy). Male sex is also a risk factor for the presence of hiatus hernia. […] Depending on its severity, it can cause spatial dissociation of the complex sphincter muscle apparatus, consisting of the diaphragmatic crura and smooth-muscle wall of the cardia. This can lead to insufficiency of sphincter muscle function in the area of the lower esophageal sphincter. […] An indication for treatment of axial hiatus hernia is only present when there is functional evidence of reflux disease, secondary disturbance of esophageal motility, or volume reflux. […] Types II and III hiatus hernia are much more rare, and due to the potential complications associated with them (chronic bleeding, anemia, incarceration), they basically represent an indication for surgery.

• #21 Causes of unsuccessful surgical treatment of hiatal hernia – Bechvaya – Pediatrician (St. Petersburg)

  https://journals.eco-vector.com/pediatr/article/view/34604

  An important aspect for the surgical treatment of hiatal hernias is the circular separation of the lower thoracic, abdominal esophagus, gastroesophageal junction, and parts of the stomach displaced into the chest cavity (or other organs with type IV hernias). […] The mechanical weakness of the diaphragm crura (e. g., hypotrophy, fibrosis) is also considered the most important factor in grafting failure. […] A decrease in the length of the esophagus (secondary or primary), along with the aforementioned conditions, is considered the most important factor but most difficult to overcome in the recurrence of hiatal hernias. […] Contraction of the cruras of the diaphragm during respiratory excursions is an important physiological factor that increases significantly the load on the plastic zone of the esophageal hiatus.

• #22 Hiatal Hernia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/178393-overview

  A hiatal hernia occurs when a portion of the stomach prolapses through the diaphragmatic esophageal hiatus. […] The size of the hiatus is not fixed, but narrows whenever intra-abdominal pressure rises, such as when lifting weights or coughing. […] The presence of a hiatal hernia compromises this reflux barrier not only in terms of reduced LES pressure but also reduced esophageal acid clearance. […] Patients with hiatal hernias also have longer transient LES relaxation episodes particularly at night time. […] These factors increase the esophageal mucosa acid contact time predisposing to esophagitis and related complications. […] Sliding hiatal hernia by far is the most common type of hiatal hernia. It occurs when the gastroesophageal junction, along with a portion of the stomach, migrates into the mediastinum through the esophageal hiatus.

• #23 Atypical and typical manifestations of the hiatal hernia – Goodwin – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/6254/html

  Hiatal hernia is a common disorder characterized by protrusion of abdominal contents through the hiatus of the diaphragm and into the mediastinum. The condition usually involves the gastroesophageal junction (GEJ), but may include any abdominal structure. The extent of gastric and GEJ involvement, as well as herniation of additional abdominal organs through the hiatus, has evolved into the anatomical classification of hiatal hernias from types I through IV. In type I hernias, the GEJ migrates above the diaphragm into the mediastinum with the fundus and remaining stomach inferior to the GEJ. Type 1 hernias are referred to as sliding hiatal hernias and account for more than 95% of hiatal hernias. The remaining categories of hiatal hernias, types II though IV, are paraesophageal hernias. In type II hernias, the GEJ remains in the normal anatomical position with the fundus herniating cephalad though the hiatus. Type III hernias are a combination of types I and II and account for more than 90% of paraesophageal hernias. With type IV hiatal hernias, additional abdominal structures other than the stomach are herniated though the hiatus. The clinical manifestations of hiatal hernias vary and are impacted by the type and size of the hernia.

• #24 Hiatal hernia – epidemiology, pathogenesis, diagnostic • Postępy Nauk Medycznych 5/2018 • Czytelnia Medyczna BORGIS

  https://www.czytelniamedyczna.pl/6473,hiatal-hernia-epidemiology-pathogenesis-diagnostic.html

  This type of hernia interferes with the anti-reflux barrier mechanisms in several ways. The lower esophageal sphincter (LES) relocates from an area with positive pressure inside the abdominal cavity to the area of low pressure in the thorax, which interferes with the activity of the sphincter. What is more, the relaxation of diaphragm crura reduces the anti-reflux barrier of the esophagus. The Hiss angle is lost in the diaphragmatic hernia, which causes higher risk of regurgitation of gastric contents. These changes, not only predispose to reflux of gastric contents to the esophagus, but also prolong the time of acid contact with the esophageal epithelium causing chronic esophagitis. […] In the paraoesophageal hernia, broadened diaphragmatic hiatus allows to relocate the stomach fundus to the thorax, the gastro-esophageal junction stays below the diaphragm.

• #25 Hiatal hernia – Wikipedia

  https://en.wikipedia.org/wiki/Hiatal_hernia

  The diagnosis may be confirmed with endoscopy or medical imaging. Endoscopy is typically only required when concerning symptoms are present, symptoms are resistant to treatment, or the person is over 50 years of age. […] Symptoms from a hiatal hernia may be improved by changes such as raising the head of the bed, weight loss, and adjusting eating habits. Medications that reduce gastric acid such as H2 blockers or proton pump inhibitors may also help with the symptoms. If the condition does not improve with medications, a surgery to carry out a laparoscopic fundoplication may be an option. […] The diagnosis of a hiatal hernia is typically made through an upper GI series, endoscopy, high resolution manometry, esophageal pH monitoring, and computed tomography (CT). […] A type I hernia, also known as a sliding hiatal hernia, occurs when part of the stomach slides up through the hiatal opening in the diaphragm.

• #26 Sliding Hiatal Hernia in a young female

  https://mhsurgery.com/single-clinical-case/sliding-hiatal-hernia-in-a-young-female

  Sliding Hiatal hernia is the protrusion of the stomach through the esophageal opening. This is a very common disease. […] In Sliding Hiatal hernia there is loss of distal esophagus and stomach location in the abdomen, with sliding of part or entire of these organs through esophagus hiatus into the chest. Hiatal hernia is a very common disease and is often associated with gastroesophageal reflux disease. […] We found that here symptoms correlated more with increased reflux of gastric contents because of a lax esophageal sphincter mechanism. […] During the surgery, we found a sliding hiatal hernia with a loss of intrabdominal length of the distal esophagus. This was causing lax lower gastroesophageal function. […] In many cases there’s no association between clinical symptoms and hernia width: large hernias can remain asymptomatic for all life, while small hernias can cause important discomfort.

• #27 A new mechanism of gastroesophageal reflux in hiatal hernia documented by high-resolution impedance manometry: a case report

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5049569/

  Gastroesophageal reflux disease (GERD) is recognized to be a multifactorial disease and several mechanisms leading to reflux have been described, nevertheless its pathophysiology has not been fully clarified. Hiatus hernia is a known risk factor for GERD since it impairs the esophagogastric junction, leading to: reduction in lower esophageal sphincter pressure; increase in the frequency of the transient lower esophageal sphincter relaxation; and impairment of esophageal clearance. […] Hiatus hernia (HH) interferes with the anatomy and physiology of the normal anti-reflux barrier through several mechanisms, such as: reduction in lower esophageal sphincter (LES) pressure; increase in the frequency of the transient LES relaxation (TLESR); and impairment of esophageal clearance. […] HH causes an anatomical and physiological interference in the normal anti-reflux barrier with several mechanisms: it reduces LES length and pressure, impairs the augmenting effects of the diaphragmatic crus, is associated with decreased esophageal peristalsis, increases the cross-sectional area of the esophagogastric junction (EGJ), and acts as a reservoir allowing reflux from the hernial sac into the esophagus during swallowing.

• #28 Giant Hiatus Hernia and Association with Gastro-Oesophageal Reflux: A Review

  https://clinmedjournals.org/articles/jcgt/journal-of-clinical-gastroenterology-and-treatment-jcgt-3-045.php?jid=jcgt

  It is reasonable to extrapolate that some of the changes seen with small HH that predispose to GORD will also apply to GHH. The potential pathophysiology is outlined below. […] Large HH have tendency towards a lower mean LOS pressure/tone, reduced LOS length and reduced intra-abdominal length of LOS contributing to the increased likelihood of GORD. It is important to note that some patients with GHH have normal LOS pressures, which may explain why reflux is not always a major symptom in this group of patients. […] HH disrupts this mechanism by: reducing the acuity of the angle between the fundus and the oesophagus and enlargement of the oesophageal hiatus with resultant widening of the oesophageal lumen. This reduces the size of the mucosal fold and its effectiveness as a flap valve. […] The presence of any HH increases an individual’s likelihood of GORD and if a HH is present, the severity of GORD is usually greater. Given that the natural history of both HH and GORD is for a slow progression, it is difficult to elucidate if larger hernias are etiologically implicated in worsening reflux or if both disorders progress in parallel.

• #29 Hiatus hernia : GI Motility online

  https://www.nature.com/gimo/contents/pt1/full/gimo48.html

  Hiatal hernia generally denotes upward displacement of the stomach through the diaphragmatic esophageal hiatus into the thoracic cavity. […] Sliding hiatal hernias contribute to gastroesophageal reflux through several different mechanisms and they also impair esophageal emptying. […] Enlarging sliding hiatal hernias cause progressive disruption of gastroesophageal reflux barrier, and large hernias cause greater gastroesophageal reflux. […] The key abnormalities in the pathogenesis of GERD are reflux of acid and pepsin from the stomach into the esophagus and a reduction in the effectiveness of esophageal acid clearance. […] Mechanistic studies of reflux disease have revealed three dominant patterns of EGJ incompetence: (1) transient LES relaxations, (2) hypotensive LES, and (3) anatomic disruption of the EGJ associated with a hiatal hernia.

• #30 Hiatal Hernia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/178393-overview

  This type of hernia interferes with the reflux barrier mechanism in several ways. […] In paraesophageal hernia, also called rolling-type hiatal hernia, the widened hiatus permits the fundus of the stomach to protrude into the chest, anterior and lateral to the body of the esophagus; however, the gastroesophageal junction remains below the diaphragm.

• #31 Hiatal hernia – Wikipedia

  https://en.wikipedia.org/wiki/Hiatal_hernia

  A type II hernia, also known as a paraesophageal or rolling hernia, occurs when the fundus and greater curvature of the stomach roll up through the diaphragm, forming a pocket alongside the esophagus. […] Type III hernias have elements of both types I and II hernias. […] Type IV hiatus hernia is associated with a large defect in the phrenoesophageal ligament, allowing other organs, such as colon, spleen, pancreas and small intestine to enter the hernia sac. […] In some unusual instances, as when the hiatal hernia is unusually large, or is of the paraesophageal type, it may cause esophageal stricture or severe discomfort. […] About 5% of hiatal hernias are paraesophageal. If symptoms from such a hernia are severe for example if chronic acid reflux threatens to severely injure the esophagus or is causing Barrett’s esophagus, surgery is sometimes recommended.

• #32 Hiatus Hernia – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/hiatus-hernia

  Etiology of hiatus hernia is usually unknown, but a hiatus hernia is thought to be acquired through stretching of the fascial attachments between the esophagus and diaphragm at the hiatus (the opening through which the esophagus traverses the diaphragm). […] There are 2 main types of hiatus hernia: Sliding hiatus hernia (most common): Gastroesophageal junction and a portion of the stomach are above the diaphragm. […] A sliding hiatus hernia is a common incidental finding on radiograph; therefore, the relationship of hernia to symptoms is unclear. Although most patients with gastroesophageal reflux disease (GERD) have some degree of hiatus hernia, 50% of patients with hiatus hernia have GERD. […] A paraesophageal hiatus hernia is generally asymptomatic but, unlike a sliding hiatus hernia, may incarcerate and strangulate. Occult or massive gastrointestinal hemorrhage may occur rarely with either type. […] An asymptomatic sliding hiatus hernia requires no specific therapy. For patients with accompanying GERD, therapy with a proton pump inhibitor should be considered. For a paraesophageal hernia, repair should be considered because of the risk of strangulation.

• #33 Hiatus hernia – UpToDate

  https://www.uptodate.com/contents/hiatus-hernia/print

  Hiatus hernia is a frequent finding by both radiologists and gastroenterologists. This topic will review the classification, pathogenesis, clinical manifestations, diagnosis, and management of a hiatus hernia. […] Hiatus hernia refers to herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm. […] A paraesophageal hernia is a true hernia with a hernia sac composed of peritoneum. It is characterized by an upward dislocation of the gastric fundus through a focal defect in the phrenoesophageal membrane. […] Type II hernias result from a localized defect in the phrenoesophageal membrane, where the gastric fundus serves as a lead point of herniation while the EGJ remains fixed to the preaortic fascia and the median arcuate ligament.

• #34 Paraesophageal Hernia (Hiatal Hernia) | Minimally Invasive and Gastrointestinal Surgery | Medical College of Wisconsin

  https://www.mcw.edu/departments/surgery/divisions/minimally-invasive-and-gastrointestinal-surgery/patient-care/gerd-and-gastrointestinal-surgery-program/paraesophageal-hernia-hiatal-hernia

  In a hiatal hernia, the stomach bulges up into the chest through that opening. […] These sliding hiatal hernias are a risk factor for gastroesophageal reflux disease (GERD), and many patients with hiatal hernias suffer from GERD symptoms such as heartburn. […] The paraesophageal hernia is less common but is more cause for concern. […] Symptomatic paraesophageal hernias are at higher risk for progressing to incarceration (stomach gets stuck resulting in obstruction) or ischemia (blood supply to the stomach is cut off) resulting in the need for emergency surgery. […] Hiatal hernias are known to contribute to GERD. […] Many patients (but not all) with paraesophageal hernias may also suffer from gastroesophageal reflux disease symptoms. […] A sliding hiatal hernia will not cause back or epigastric pain like a paraesophageal hernia can.

• #35 Hiatus Hernia – Rolling – Sliding – Management – TeachMeSurgery

  https://teachmesurgery.com/general/gastric/hiatus-hernia/

  The vast majority of hiatus hernias are completely asymptomatic. […] For those with symptoms, the majority present with gastro-oesophageal reflux disease, mainly epigastric pain, made worse by lying flat. […] The majority of cases are diagnosed on upper GI endoscopy (OGD), as the most common symptom is reflux or epigastric pain. […] Surgical management is indicated when ongoing symptoms or complications of GORD (e.g. Barretts), despite maximal medical therapy. […] Increased risk of complications e.g. obstruction, strangulation, or volvulus. […] Hiatus hernia surgery typically involves a cruroplasty followed by a fundoplication, either laparoscopically (more common) or open. […] Hiatus hernias, especially the rolling type, are prone to incarceration, obstruction and strangulation.

• #36 Clinical Significance of Hiatal Hernia

  https://www.gutnliver.org/journal/view.html?volume=5&number=3&spage=267

  The mechanism of reflux due to GEJ incompetence can be summed down to three: 1) tLESRs, 2) hypotensive LES, and 3) anatomical defect such as hiatal hernia. […] Hiatal hernia is a condition in which parts of the abdominal contents, mainly the GEJ and the stomach, are proximally displaced above the diaphragm through the esophageal hiatus into the mediastinum. […] Loss of elasticity of the phrenoesophageal ligament/membrane may also be caused by excessive contraction of the esophageal longitudinal muscle, increased abdominal pressure as occurs in power athletes, pregnancy, genetic predisposition, and previous surgery. […] The significance of sliding hiatal hernia is its relation with GERD in which the symptoms worsen with increasing size of the sliding hiatal hernia. […] Many studies have demonstrated that hiatal hernia is closely related to reflux symptoms, reflux esophagitis, Barrett’s esophagus and esophageal adenocarcinoma.

• #37 | General Surgeon & Foregut Surgeon located in Lone Tree, CO | Institute of Esophageal and Reflux Surgery

  https://www.iersurgery.com/content/large-hiatal-hernia-paraesophageal-hernia

  A hiatal hernia occurs when the upper part of the stomach goes up through the opening in the diaphragm (the muscle that separates the chest and the abdomen) that is normally occupied by the esophagus. […] The drawings below illustrate how the development of a hiatal hernia leads to unfolding of the valve mechanism, resulting in a funnel-shaped valve that increases the ability of stomach contents to reflux back into the esophagus (large arrow on right). […] For the most part, hiatal hernias weaken the effectiveness of the antireflux barrier and increase the severity of gastroesophageal reflux disease. […] The diaphragm helps the valve between the stomach and esophagus work. It is common in people with a hiatal hernia to experience reflux as the valve cannot work as well. […] Some hiatal hernias can become quite large; these are called paraesophageal hernias. This type of hiatal hernia can become serious and requires surgery to repair it, regardless of if you have symptoms.

• #38 Hiatus hernia : GI Motility online

  https://www.nature.com/gimo/contents/pt1/full/gimo48.html

  Patients with a normal EGJ require inhibition of both the intrinsic LES and extrinsic crural diaphragm for reflux to occur; physiologically this occurs only in the setting of a TLESR. […] In contrast, patients with hiatal hernia may exhibit preexisting compromise of the hiatal sphincter. […] Acquired anatomic changes attributable to hiatus hernia may alter the compliance at the relaxed EGJ, thereby decreasing the resistance to gastroesophageal flow. […] Once the hiatus is physiologically disrupted, it is no longer protective in preventing gastroesophageal reflux. […] The defining abnormality with esophagitis is excessive mucosal acid exposure, which, in turn, is dependent on both the frequency of reflux events and the time required to achieve acid clearance for each event. […] The variable associated with the greatest impairment of esophageal acid clearance was hiatus hernia. […] Re-reflux occurs predominantly during inspiration and can be attributed to loss of the normal one-way valve function of the crural diaphragm.

• #39 Hiatus hernia pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hiatus_hernia_pathophysiology

  It is understood that hiatus hernia is the result of either: Decreased elastin of phrenoesophageal membrane due to aging, Imbalance in pressure gradient between intra-abdominal pressure and intra-thoracic pressure leading to the esophagogastric junction being displaced into normal hiatus. A rise in intraabdominal pressure and fall in intra-thoracic pressure may lead to development of hernia. […] The symptoms in hiatus hernia are the result of reflux esophagitis and the mechanisms involved include: Low resting LES pressure, Prolonged time taken to clear acid, Delayed gastric emptying, Transient LES relaxation which occurs more frequently in hiatus hernia. […] The pathophysiology of hiatus hernia depends on the histological subtype: Paraesophageal hernia are less common and have lower incidence of gastroesophageal reflux disease. The initial clinical presentation including dysphagia, postprandial nausea and vomiting are result of impaired gastric emptying due to mechanical obstruction. It enlarges with time and results in symptoms are related to the abnormal intra-thoracic location of the stomach. The hiatus hernia reduces LES sphincter.

• #40 Pathophysiology of Gastroesophageal Reflux Disease and Hiatal Hernia | Pearson’s General Thoracic

  https://ebook.sts.org/sts/view/Pearsons-General-Thoracic/1418525/all/Pathophysiology_of_Gastroesophageal_Reflux_Disease_and_Hiatal_Hernia

  Transient lower esophageal sphincter relaxation (TLESR) is a dominant mechanism of lower esophageal sphincter (LES) dysfunction leading to gastro-esophageal reflux disease (GERD). Other mechanisms of GERD include a hypotensive lower esophageal sphincter (LES), and anatomic disruption of the gastroesophageal junction. […] In the postprandial period, gastro-esophageal reflux (GER) originates from an acid pocket that forms as a consequence of the pooling of newly secreted acid in the proximal portion of the stomach above ingested chyme. Hiatal hernia (HH) contributes to the formation, size, and position of the acid pocket. […] Axial HHs, characterized by the permanent supra-diaphragmatic migration of the E-G junction contribute to the impairment of cardia continence. Hiatal insufficiency, concentric HH, and short esophagus are signs of migration. These radiological/anatomical conditions are generally associated with severe, persistent GERD. The distance between the E-G junction and the diaphragm, not the size of hernia, influences the degree of cardiac incontinence and the severity of GERD.

• #41 A new mechanism of gastroesophageal reflux in hiatal hernia documented by high-resolution impedance manometry: a case report

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5049569/

  The most probable hypothesis could be that reflux is due to a transient increase in hernial sac pressure: the hernial sac acts as a reservoir increasing its pressure to overcome the basal LES pressure. As a consequence, the gastric content could reflux from the hernial sac into the esophagus, not during swallowing phase like Gordon et al proposed, but after the end of each peristaltic wave until the following swallow. The mechanism we have described may be similar to what happens in the acid pocket of patients with HH, with the difference that in our case reflux occurs even in absence of TLESRs and with a perfectly working LES, despite HH.

• #42

  http://www.annalsgastro.gr/index.php/annalsgastro/article/view/2747

  Gastroesophageal reflux disease (GERD) is recognized to be a multifactorial disease and several mechanisms leading to reflux have been described, nevertheless its pathophysiology has not been fully clarified. […] Hiatus hernia is a known risk factor for GERD since it impairs the esophagogastric junction, leading to: reduction in lower esophageal sphincter pressure; increase in the frequency of the transient lower esophageal sphincter relaxation; and impairment of esophageal clearance. […] We describe an interesting case of a patient with a sliding hiatus hernia, with symptoms suggestive of GERD, in which HRIM revealed a new possible mechanism through which hiatus hernia may lead to GERD.

• #43 Clinical Significance of Hiatal Hernia

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=284&vmd=Full

  The presence of hiatal hernia more than doubled the risk of developing adenocarcinoma of the esophagus and gastric cardia. […] These above mentioned associations between hiatal hernia and reflux symptoms, reflux esophagitis, Barrett’s esophagus and esophageal adenocarcinoma are largely due to the disruption of many of the antireflux mechanisms that leads to increased esophageal acid exposure.

• #44 Atypical and typical manifestations of the hiatal hernia – Goodwin – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/6254/html

  The true incidence and prevalence of hiatal hernia is difficult to quantify, as many patients remain asymptomatic and undiagnosed from the hernia. Of patients with symptoms, manifestations may be wide-ranging and include reflux, obstruction, pulmonary, and cardiac symptoms. Manifestations may be typical or atypical and comprise a broad differential that can make the diagnosis difficult for the clinician based on history alone. […] The presence of a hiatal hernia is closely related to reflux symptoms and associated complications. Patients with a hiatal hernia are significantly more likely to present with GERD symptoms compared to those without a hiatal hernia. Furthermore, symptomatic GERD patients are more likely to have a hiatal hernia than those without symptoms. GERD symptoms are more common in Type 1 hiatal hernias, and the size of the hernia can impact symptom severity.

• #45 Clinical Significance of Hiatal Hernia

  https://www.gutnliver.org/journal/view.html?volume=5&number=3&spage=267

  The presence and size of the hiatal hernia were important, with the majority of patients with severe esophagitis having hiatal hernia. […] The proximal displacement of the LES in hiatal hernia further compromises the competence of the GEJ due to the loss of the intra-abdominal segment of the LES, because the intra-abdominal location of the LES per se is considered to serve as a valve by being exposed to the positive abdominal pressure. […] The advent of high resolution manometry has added new dimension to our knowledge on the esophageal physiology, and the long disputed role of hiatal hernia on GERD is sure to be fully unraveled in the near future.

• #46 Hiatus hernia | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/hiatus-hernia/

  A hiatus hernia, or hiatal hernia, is when part of the stomach squeezes up into the chest through an opening (hiatus) in the diaphragm. […] Its not exactly clear what causes hiatus hernia, but it may be the result of the diaphragm becoming weak with age, or pressure on the abdomen. […] Hiatus hernia can sometimes occur in newborn babies if the stomach or diaphragm doesnt develop properly. […] Hiatus hernias that slide in and out of the chest area (sliding hiatus hernias) can cause gastro-oesophageal reflux disease (GORD). This is where stomach acid leaks into the oesophagus (gullet). This can damage the oesophagus, increasing the risk of problems. […] Damage to the lining of the oesophagus (oesophagitis) caused by stomach acid can lead to the formation of ulcers. […] Repeated damage to the lining of your oesophagus can lead to the formation of scar tissue. If the scar tissue is allowed to build up, it can cause your oesophagus to become narrowed. This is known as oesophageal stricture.

• #47 Hiatus hernia | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/hiatus-hernia/

  Repeated damage to the oesophagus can also lead to changes in the cells lining your lower oesophagus. This is a condition known as Barretts oesophagus. […] In some cases, a hiatus hernia causes part of the stomach to push up next to the oesophagus. This is known as a para-oesophageal hiatus hernia. GORD doesnt usually occur in these cases, but theres a risk of the hernia becoming strangulated.

• #48 Atypical and typical manifestations of the hiatal hernia – Goodwin – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/6254/html

  The strong association between hiatal hernia and GERD syndromes implies that many of the atypical presentations of GERD may manifest in a hiatal hernia. These atypical manifestations are often extraesophageal and rarely occur in isolation without concurrent typical symptoms of GERD. […] As previously discussed, hiatal hernias disrupt different antireflux mechanisms which lead to the strong association between hiatal hernia and typical and atypical manifestation of GERD. Furthermore, the mere presence of a hiatal hernia can produce a number of typical and, less commonly, atypical gastrointestinal symptoms and complications, unrelated to reflux. These symptoms result from the physical herniation of the stomach and additional abdominal structures through the hiatus. […] Typical obstructive gastrointestinal symptoms of a hiatal hernia include early satiety, nausea, and bloating. These symptoms can be exacerbated with oral intake.

• #49 Atypical and typical manifestations of the hiatal hernia – Goodwin – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/6254/html

  Atypical gastrointestinal obstructive manifestations of a hiatal hernia occur with less frequency. Progressive herniation of the stomach and additional abdominal structures can result in gastric outlet obstruction, gastric volvulus, or intestinal obstruction. […] Other atypical manifestations of a hiatal hernia include gastrointestinal bleeding and anemia. […] Hiatal hernias can present with non-gastrointestinal symptoms, obscuring the diagnosis in such patients on initial presentation. As a hiatal hernia enlarges and more stomach or additional abdominal structures move into the mediastinum, respiratory manifestations may predominate. Typical pulmonary symptoms with hiatal hernia include dyspnea and atelectasis as a result of pulmonary compression. […] The increased prevalence of GERD with hiatal hernias contribute to the association of a hiatal hernia with pulmonary fibrosis. […] Although this symptomatology is not cardiac in nature, hiatal hernias infrequently manifest as cardiac arrhythmias. In a large population-based study, hiatal hernias were associated with an increased prevalence of atrial fibrillation.

• #50

  https://journals.lww.com/ajg/fulltext/2024/10001/s3106_a_case_of_a_type_iv_hiatal_hernia_presenting.3107.aspx

  A hiatal hernia occurs when contents of the abdomen protrude into the thoracic cavity through the esophageal hiatus. […] Type IV hiatal hernias, the most severe, involve the herniation of abdominal viscera, including organs such as the spleen, colon, or small intestine into the thorax. […] This case highlights patterns of clinical presentation for Type IV hiatal hernias and its potential to cause bradycardia. The mechanism by which a hiatal hernia causes bradycardia is direct, mechanical compression over the heart or its connected structures. […] In this case, the large sliding hernia contained a portion of the proximal transverse colon, which likely compromised the vagus nerve, the cardiac chambers, or both, leading to sinus bradycardia. […] Surgical intervention not only addresses mechanical obstruction, but also alleviates the cardiac symptoms caused by the hernia. Post-surgical improvement in symptoms and resolution of bradycardia further confirms the causative role of the hiatal hernia in this patients clinical presentation.

• #51 Acid Reflux: Understanding Hiatal Hernia Symptoms – Dr. Adam S. Harris, M.D.

  https://surgeonadamharris.com/acid-reflux-hiatal-hernia-symptoms/

  The protrusion of the stomach through the diaphragm in hiatal hernia can disrupt the normal functioning of the LES, leading to the backflow of stomach contents into the esophagus. […] Dysphagia in hiatal hernia can occur due to the protrusion of the stomach through the diaphragm, causing mechanical obstruction or narrowing of the esophagus. […] Shortness of breath in hiatal hernia occurs due to the protrusion of the stomach through the diaphragm, which can affect the position and movement of the diaphragm during breathing. […] The protrusion of the stomach into the chest cavity can increase pressure on the diaphragm, limiting its range of movement. […] Hiatal hernia can contribute to frequent hiccups due to its impact on the diaphragm. The protrusion of the stomach through the diaphragm can irritate or put pressure on the diaphragm, leading to an increased frequency of hiccups.

• #52

  https://www.polradiol.com/Small-hiatal-hernia-as-a-risk-factor-of-atrial-fibrillation,126009,0,2.html

  Hiatal hernia (HH) is considered a risk factor of atrial fibrillation (AF). […] Small HH, e.g. under or equal to 2 cm, are associated with a higher risk of AF compared to the control group, which was not observed for bigger HH. […] The presence of small HH may be a risk factor of AF. […] Our research demonstrated that HH with a size smaller than 2 cm is correlated with a higher risk of atrial fibrillation. […] In our statistical analysis HH less than or equal to 2 cm is a risk factor of AF, which was not observed for large HH.

• #53 Massive hiatal hernia involving prolapse of the entire stomach and pancreas resulting in pancreatitis and bile duct dilatation: a case report | Surgical Case Reports | Full Text

  https://surgicalcasereports.springeropen.com/articles/10.1186/s40792-020-0773-8

  Hiatal hernia is defined by the permanent or intermittent prolapse of any abdominal structure into the chest through the diaphragmatic esophageal hiatus. […] The etiology can be folding and resultant obstruction of the main pancreatic and extrahepatic biliary ducts to drainage. […] A rare massive hiatal hernia, involving the stomach and pancreatic body and tail, can cause acute pancreatitis with bile duct dilatation. […] The mechanism of pancreatitis due to herniation of the pancreas is presumed to be repeated damage of the pancreas and ischemia as a consequence of intermittent stretching of the blood vessels supplying the pancreas. […] Another conceivable mechanism includes distortion of the pancreas, which impedes the normal pancreatic outflow, thereby leading to intraductal hypertension resulting in inflammation.

• #54 Massive hiatal hernia involving prolapse of the entire stomach and pancreas resulting in pancreatitis and bile duct dilatation: a case report | Surgical Case Reports | Full Text

  https://surgicalcasereports.springeropen.com/articles/10.1186/s40792-020-0773-8

  In type IV HH cases, pancreatic herniation is a rare phenomenon, because the head segment of the pancreas and duodenum are positioned in the retroperitoneum and fixed by Treitz ligament. […] However, extension of the transverse mesocolon owing to the increase in intra-abdominal pressure induces loosening of the posterior fascia, which results in mobilization and herniation into the chest. […] The diagnosis is confirmed by elevation of pancreatic enzyme and imaging finding of pancreatic herniation with inflammatory reaction secondary to pancreatitis (peripancreatic fluid collections, interstitial edematous, stranding of mesenteric fat). […] Although it is difficult to clearly prove that herniation of pancreas was the primary pathogenesis of acute pancreatitis, most cases were diagnosed based on the exception of other common pathogenesis for acute pancreatitis, such as gallstone, choledocholithiasis, and alcohol. […] Considering the serious complications of type IV HH, patients must be followed closely and undergo surgical repair early, after controlling the pancreatic inflammation, before serious complications occur.

• #55 | General Surgeon & Foregut Surgeon located in Lone Tree, CO | Institute of Esophageal and Reflux Surgery

  https://www.iersurgery.com/content/large-hiatal-hernia-paraesophageal-hernia

  When a hiatal hernia leads to deformation of the antireflux barrier, it is repaired by performing a laparoscopic fundoplication. […] Although up to 90% of patients with GERD have a hiatal hernia, the degree of that hiatal hernia is variable, and in many patients the hiatal hernia is fairly minimal (less than 2cm in height). […] Large hiatal hernias/paraesophageal hernias can cause chest pain (especially after eating), shortness of breath, and early satiety (getting full quickly).

• #56 Giant Hiatus Hernia and Association with Gastro-Oesophageal Reflux: A Review

  https://clinmedjournals.org/articles/jcgt/journal-of-clinical-gastroenterology-and-treatment-jcgt-3-045.php?jid=jcgt

  The existence of HH has been recognized for centuries, but the precise pathophysiology that leads to this condition is not known. Important factors include raised intra-abdominal pressure causing displacement of the GOJ into the thorax, weakening of the phreno-oesophageal ligament due to depletion of elastin fibres, oesophageal shortening secondary to longstanding reflux disease or vagal stimulation and age-related or congenital widening of the oesophageal hiatus. […] Symptomatic GORD is common in individuals with HH. The normal anatomical alignment of the GOJ has important functional implications and displacement from the diaphragmatic hiatus predisposes patients to reflux. There is an established relationship between HH, reflux disease and oesophagitis which is likely to persist for patients with giant HH. However, in this group, GORD may also be due to poor gastric emptying from relative gastric obstruction at the hiatus.

• #57 Large hiatus hernia: time for a paradigm shift? | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-022-01705-w

  In the twentieth century most large, even asymptomatic, paraesophageal herniae (PEH) were repaired in order to avoid the risk of complications which could lead to the patients demise. […] However, a Markov analysis in 2002 did put the risk of non-intervention into perspective. […] A subsequent similar analysis showed an improvement in Quality-of-Life (QoL) expectancy by 5 months with non-operative approach for those patients. […] Patients with large herniae often present with other atypical symptoms. […] A study on 30 patients with giant hiatal herniae showed resolution of preoperative shortness of breath after repair. […] Patients can also present with syncopal episodes or dizziness due to cardiac compromise from mass effect of the hernia on the heart. […] Recent investigations have also shown post-prandial reduction in ejection fraction and right atrial/ventricular volume in patients with 30% intrathoracic hernia.

• #58 Hiatal hernia – Wikipedia

  https://en.wikipedia.org/wiki/Hiatal_hernia

  A hiatal hernia or hiatus hernia is a type of hernia in which abdominal organs (typically the stomach) slip through the diaphragm into the middle compartment of the chest. This may result in gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR) with symptoms such as a taste of acid in the back of the mouth or heartburn. Other symptoms may include trouble swallowing and chest pains. Complications may include iron deficiency anemia, volvulus, or bowel obstruction. […] The most common risk factors are obesity and older age. Other risk factors include major trauma, scoliosis, and certain types of surgery. […] There are two main types: sliding hernia, in which the body of the stomach moves up; and paraesophageal hernia, in which an abdominal organ moves beside the esophagus.

• #59

  https://www.ijsurgery.com/index.php/isj/article/view/9204

  Hiatal hernias are a common occurrence in the western population, with an estimated prevalence of 15% to 20%. These hernias may become symptomatic and lead to gastroesophageal reflux disease (GERD), dysphagia, dyspnoea, and may affect cardiac and respiratory function. Being overweight and elderly are the key risk factors in its development. Other known risk factors include: multiple pregnancies, history of oesophageal surgery, partial or full gastrectomy and certain disorders of the skeletal system associated with bone decalcification and degeneration. […] Marchand P. The anatomy of esophageal hiatus of the diaphragm and the pathogenesis of hiatus herniation. Thorac Surg. 1959;37:81-92. […] Marchand P. The anatomy of esophageal hiatus of the diaphragm and the pathogenesis of hiatus herniation. J Thorac Surg. 1959;37:81-92.

• #60 Literature Review: A Surgeon’s View of Recurrent Hiatal Hernia

  http://www.scielo.org.co/scielo.php?pid=S0120-99572015000400008&script=sci_arttext&tlng=en

  Recurrent hiatal hernias are a common pathology that generate a diagnostic and therapeutic challenge for surgeons and gastroenterologists. […] The pathophysiologies of primary hiatal hernias and recurrent hiatal hernias are not entirely clear. Although the molecular and cellular bases have not been fully described, differences among patients with hiatal hernias point to either congenital or acquired defects. […] There are several factors that influence recurrence. […] Negative pressure in the chest and positive pressure in the abdomen. […] Intra-abdominal pressure (associated comorbidities: pulmonary diseases and being overweight). […] Patient age (young patients = prolonged exposure). […] Size of the esophageal hiatus (difficult to approach pillars of tendon). […] Fibrous scar tissue from previous procedure. […] A short esophagus. […] Inadequate dissection of the esophagus at the time of primary repair. […] Incomplete release of the hernia sac. […] Inadequate closure and low hiatal pressure.

• #61 Obesity and its Link to Hiatal Hernias

  https://surgeonadamharris.com/obesity-and-its-link-to-hiatal-hernias/

  Obesity itself is a significant factor in the development of hiatal hernias. Excessive intra-abdominal fat can increase the pressure on the stomach and diaphragm, leading to herniation through the hiatus. Changes in pressure within the abdomen, such as the increased intra-abdominal pressure common in obese individuals, can also contribute to the development and worsening of hiatal hernias. Additionally, obesity may weaken the lower esophageal sphincter, further increasing the risk of acid reflux and hernia formation.

• #62 Causes of unsuccessful surgical treatment of hiatal hernia – Bechvaya – Pediatrician (St. Petersburg)

  https://journals.eco-vector.com/pediatr/article/view/34604

  Surgical treatment of hiatal hernias involves the restoration of the normal anatomy between the esophagus, stomach, and diaphragm or other organs of the abdominal cavity and retroperitoneal space with type IV hernias. […] The most serious and unresolved problem in this surgical field is the high recurrence rate of hiatal hernias in the long term after surgery, which reaches 10%15% to 30%40%, and even 60%. […] The causes of unsatisfactory outcomes of surgical treatment of hiatal hernia can be conditionally divided into several categories: group 1 consists of technical errors in performing surgical intervention, and group 2 comprises aspects of the anatomical structure and physiological activity of the diaphragm, esophagus, and stomach. […] Insufficient mobilization of the abdominal esophagus, stomach, and hernial sac during surgery is one of the common mistakes in practice and can cause a relapse of the hiatal hernia.

• #63 Surgical strategies for recurrent hiatal hernia: three-point fundoplication fixation | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-025-02760-9

  The management of a recurrent (symptomatic) hiatal hernia remains controversial. […] The key is not only to accurately close the hernia ring but also to fix the fundoplication to reduce the impact on the tissue around the hiatus to reduce the incidence of recurrence. Our three-point fixation technique showed promising effects in preventing recurrence but needs further study. […] Recurrence of hiatal hernia is the main cause of hiatal hernia reoperation, and it is also a challenge for surgeons. […] Many factors contribute to the recurrence of hiatal hernias, including the size of the primary hernia ring, the use of mesh prior to surgery, and the decrease in strength in front of the esophagus. […] The pathophysiology of recurrent hiatal hernia may result from widening of the anterior and left lateral portions. […] The balance between a tension-free hiatus and tight closure of the hiatus is difficult to achieve. […] We theorize that three-point fixation would be an effective measure to prevent the recurrence of hiatal hernias and make the operation easier and more valid.

• #64

  https://link.springer.com/article/10.1007/s00464-021-08887-z

  Hiatal hernia recurrence following surgical repair is common. We sought to define the most common anatomic location and mechanism for hiatal failure to inform technical strategies to decrease recurrence rates. […] Mechanism of recurrence was defined as disruption of the previous repair or dilation of the hiatus. […] Video analysis revealed anterior recurrences were most common (67%), followed by circumferential (29%). […] The mechanism of recurrence was dilation in 74% and disruption in 26%. Disruption as a mechanism was most common in circumferential hiatal failures. […] The most common location and mechanism for hiatal hernia recurrence is anterior dilation of the hiatus. Outcomes following techniques designed to reinforce the anterior hiatus and perhaps to prevent hiatal dilation should be explored.

• #65 Causes of unsuccessful surgical treatment of hiatal hernia – Bechvaya – Pediatrician (St. Petersburg)

  https://journals.eco-vector.com/pediatr/article/view/34604

  Peristaltic contractions of the esophagus, which are an integral component of its physiological function, are also considered a factor that increases the risk of repeated displacement of the stomach into the mediastinum. […] Thus, surgical treatment outcomes of hiatal hernia are affected by diverse causes and factors. Some of them are amenable to elimination or correction, while others do not yet have a final solution and require further experimental and clinical studies.

• #66 Large hiatus hernia: time for a paradigm shift? | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-022-01705-w

  Laparoscopic large hiatal hernia (LHH) repair remains a challenge despite three decades of ongoing attempts at improving surgical outcome. […] Its rarity and complexity, coupled with suboptimal initial approach that is usually best suited for small symptomatic herniae have contributed to unacceptable higher failure rates. […] We have therefore undertaken a systematic appraisal of LHH with a view to clear out our misunderstandings of this entity and to address dogmatic practices that may have contributed to poor outcomes. […] The absence of good quality evidence has resulted in lack of clarity in EAES and SAGES guidelines, thus leaving the decision to the individual surgeons. […] It is therefore not surprising that a survey of international surgeons has shown wide variations of techniques and use of mesh.

• #67

  https://link.springer.com/article/10.1007/s00464-023-10005-0

  Mesh augmentation is a highly controversial adjunct of hiatus hernia (HH) surgery. […] In an attempt to overcome the undesirable characteristics of permanent synthetic meshes, absorbable allogenic and xenogeneic materials (biomeshes) have been introduced and widely promoted. […] New-generation long-term absorbable biosynthetic meshes (BSM) have recently been developed to combine the advantages and avoid the downsides of synthetic materials and biomeshes. […] Although promising in concept, only few studies have reported clinical outcomes after P4HB reinforcement in HH repair. […] The present study is currently the largest reporting on BSM augmentation in HH repair and adds further evidence to the existing literature. […] In agreement with the previously published experience, we may therefore conclude that BSM with P4HB patches can be safely performed at the hiatus.

• #68 Large hiatus hernia: time for a paradigm shift? | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-022-01705-w

  Collis gastroplasty (CG) is performed in the setting of a LHH repair whenever a shortened esophagus (SE) is diagnosed. […] There are some conditions that predispose to the shortened esophagus such as long esophageal stricture, extensive Barretts changes, or grade 3 or 4 esophagitis. […] Such inconsistency suggests that CG is perhaps being done for the wrong indication. […] In fact, the SE can only reliably be diagnosed intraoperatively. […] The repair phase is also harder especially whilst suturing of the stomach to the diaphragm and right crus during a Dor anterior fundoplication. […] Hence additional mesh reinforcement is often required. […] Two meta-analysis (MA) in 2016 have shown a benefit of the mesh in reducing post-operative recurrence. […] Does the choice of mesh [PTFE, polypropylene (PP), SIS] make any difference?

• #69

  https://link.springer.com/article/10.1007/s00464-023-10005-0

  Although from a physical point of view it may seem obvious that meshes increase the tensile strength of the reconstructed hiatus, the general indication for mesh augmentation in HH surgery remains a hotly contested topic. […] Indeed, mesh augmentation at the hiatus is far from standardized and there are various materials (synthetic, biosynthetic, biological, absorbable, and non-absorbable) with diverging characteristics on the market. […] With this in mind, and considering the fact that up to 75% of recurrences are located anteriorly, we have changed our institutional technique of mesh configuration by placing the recess for the abdominal esophagus 12 cm below the center of the patch to achieve an even wider coverage of the anterior hiatus. […] In conclusion, this study confirms that reinforcement of crurorrhaphy with the Phasix ST (BD) P4HB patch is feasible and clinically effective in the short- and mid-term follow-up.

• #70 Large hiatus hernia: time for a paradigm shift? | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-022-01705-w

  In summary, there is currently no categorical significant benefit of mesh usage in reducing reoperation rate. […] Mortality related to the mesh itself is associated with tacking and mesh erosion. […] The Society of American Gastroenterological Endoscopic Surgeons (SAGES) guidelines from 2015 is equivocal in its recommendation regarding the role of mesh in hiatal hernia repair, reiterating the lack of strong evidence on its usefulness. […] Overall, the mortality and major morbidity of LHH mesh repair is acceptable.

• #71 Achalasia and Hiatal Hernia: A Rare Association and a Therapeutic Challenge

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm22151

  Sliding hiatal hernia is a condition that involves the herniation of the gastroesophageal junction and the proximal stomach in the thorax via the diaphragmatic hiatus. It is considered a major cause of gastroesophageal reflux disease (GERD), due to the decreased lower esophageal sphincter (LES) pressure associated with the intrathoracic position of the LES. […] Achalasia is a rare esophageal motility disorder, occurring in up to 1 per 10 000, defined by an impaired relaxation of the LES and the absence of normal peristalsis. […] The association of a hiatal hernia and achalasia represents a therapeutic challenge, since all achalasia treatment aim at decreasing the integrated relaxation pressure and the lower esophageal sphincter pressure, with the risk of inducing severe post treatment gastroesophageal reflux in patients with achalasia.

• #72 Achalasia and Hiatal Hernia: A Rare Association and a Therapeutic Challenge

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm22151

  We observed a 4% prevalence of hiatal hernia among patients with achalasia and did not record any specific clinical or manometric presentation, or treatment outcome pattern following various endoscopic treatment modalities in patients with achalasia and hiatal hernia. The presence of hiatal hernia neither did influence the outcome of endoscopic treatment nor did the presence of hiatal hernia affect the occurrence of erosive esophagitis after POEM. […] Conceptually, the association of achalasia and hiatal hernia is rare since patients with achalasia typically have a long esophagus extending well below the diaphragm. The mechanism of the association between the 2 conditions in unknown. It could involve the occurrence of idiopathic achalasia in a patient with prior hiatal hernia […] In conclusion, hiatal hernia associated with achalasia occurred in 4% of cases. The finding of a hiatal hernia associated with achalasia should not affect the choice of the treatment, since therapeutic outcomes and gastroesophageal reflux symptoms are similar to patients without hiatal hernia.

• #73 Hiatus hernia pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hiatus_hernia_pathophysiology

  It is understood that hiatus hernia is the result of either decreased elastin of phrenoesophageal membrane due to aging or imbalance in pressure gradient between intra-abdominal pressure and intra-thoracic pressure leading to the esophagogastric junction being displaced into normal hiatus. A rise in intra-abdominal pressure and lower thoracic pressure can cause hernia. Occasionally, esophageal shortening pulls the junction into the hiatus. This physiological shortening may occur as a normal response to swallowing. The LES is shorter and weaker in large hiatus hernia and have severe reflux symptoms and trauma. Paraesophageal hernia are less common and have lower incidence of gastroesophageal reflux disease. […] The parts of diaphragm involved in the pathophysiology of the hiatus hernia include: Crura (crus of diaphragm), Esophageal hiatus (opening in diaphragm for esophagus at T10).

• #74 Hiatal Hernia Treatment in Appleton, WI | Peter Janu, MD

  https://peterjanumd.com/heartburn-treatment-hiatal-hernia-treatment/

  Hiatal hernia develops in the muscle of the diaphragm. Normally the anatomy allows the passage of the esophagus, which is the muscle tube that connects the mouth to the stomach, through the chest. The passage through the diaphragm is the diaphragmatic hiatus. That muscular passageway contributes to the barrier that prevents the contents of the stomach from going the wrong direction. A hiatal hernia means that the passageway enlarges. The larger or wider the passage becomes, the less it can contribute to the valve barrier at the connection between the esophagus and stomach. Additionally, the larger passageway allows the stomach to slide upwards into the chest, leading to more symptoms including pain, bloating, trouble swallowing, and increased issues of heartburn and reflux. […] The hernia is repaired with stitches to reduce the size of the hole back to its normal size, snug around the esophagus. Depending on the defect, sometimes the repair is reinforced with mesh. To complete the repair, the valve mechanism is also addressed at the time of hernia repair. This is accomplished with a traditional fundoplication approach, Nissen (complete) or Toupet (partial) fundoplication, or alternatively with a magnetic sphincter augmentation implant or even an endoscopic reconstruction approach.

• #75 The relationship of hiatal hernia and gastroesophageal reflux symptoms—two-sphincter hypothesis: a review – Andrews – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/5841/html

  Anti-reflux surgery has also been used to argue for the concept of a two-sphincter barrier by restoring LES length and aligning the crural diaphragm along with it. […] The results of these studies support the two-sphincter hypothesis by demonstrating that a structurally intact LES and hiatal canal are necessary for an effective reflux barrier.

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