Hiatus hernia is a fairly common condition among the population due to a malfunction of the esophageal sphincter. Tobacco, obesity, stress or certain postures are some of the factors that can cause this weakening. Patients must undergo hiatus hernia when they do not respond to medical treatment. There are different surgical techniques that will be more or less adequate depending on the patient. Therefore, it is important to undergo previous analyzes that certify the suitability of each type of intervention.
When we eat, food travels from the mouth to the stomach through the esophagus. In the lower part of the same there is a valve, lower esophageal sphincter (LES), which allows the passage of food but prevents reflux of acid content of the stomach into the esophagus. When this valve does not work properly, it produces reflux that irritates the esophagus, causing acidity or other symptoms such as vomiting, difficulty swallowing, nocturnal cough, aphonia, etc.. All this can damage the esophagus.
Some people have a genetically weak EEI valve, in other people, certain foods, coffee, tobacco, tight clothing, intense physical exercise or certain positions such as bending or lying down can cause reflux due to relaxation of the LES.. Hiatal hernia is very common in patients with reflux, but not all patients with hiatal hernia have reflux.
Treatment in 3 steps
Reflux is usually treated in three progressive steps:
Changes in lifestyle : Modifying the diet, eliminating alcohol or tobacco, losing weight, changing the position of the bed etc.
Medical treatment : Through antacids or medications that decrease the production of acid by the stomach.
Surgery: Patients who do not respond to changes in lifestyle or medical treatment may benefit from surgical treatment
There are several surgical techniques to solve the reflux and its application depends on each case. The most frequent is the Nissen Fundoplication, which consists in the creation of a new valve in the lower esophagus by wrapping it with a cuff made with part of the stomach.. It is a very effective technique controlling reflux in a definitive way. Currently this technique is performed by laparoscopy which reduces postoperative pain and hospital stay with better cosmetic result and a much faster return to normal activity than when conventional surgery is used.
Not all patients are candidates for this type of surgery, a complete analysis must first be made and their alternatives, risks and benefits discussed with their surgeon. In most cases this type of surgery has no side effects and patients recover satisfactorily.