The valve between the food pipe and stomach prevents acid and food into regurgitating upwards into food pipe. This valve is situated just below the diaphragmatic opening inside the abdomen.
this valve migrates upwards into the chest, carrying a small part of stomach, it looses its ability to remain closed, and thus remains open. This condition is called Hiatus hernia of Sliding type. This will cause acid and food to regurgitate into food pipe, especially on lying down or at night.
Symptoms are :
- Heart burn off & on
- Chest pain white swallowing
- Bouts of cough & heartburn at night, causing the person to get up.
- Sore throat, asthma, cough due to acid coming up to throat
- Blood vomiting due to ulcers in esophagus.
The other type of Hiatus Hernia is when the valve remains in the abdomen, but a part of stomach migrates up into the chest. This is called Paraoesophageal Hernia. This can cause chest pain after eating occasionally a large part of stomach can migrate into chest. This can suddenly undergo a twist ( volvulus) and cause severe pain and requires emergency surgery.
Diagnosis is done by
- Barium swallow
- 24 hour pH
Treatment consists of
- Medical management by antacids,PPI drugs and sleeping with head up.
- Surgery is done for :
- 1. failure of medical treatment,
- 2. Need to take PPI tablets every day for indefinite period
- 3. Complications like Blood vomitting or narrowing of food pipe ( Peptic stricture) or Barretts Esophagus
Surgery: Nissen’s Fundoplication
Surgery is done Laparoscopically
- After insufflating the abdomen camera port and 3 smaller ports for instruments are put inside through small punctures
- The stomach and the Esophagogastric valve are pulled back into abdomen.
- The lower part of esophagus is dissected free of all attachments and a loop is passed around it to lift it up.
- The diaphragmatic opening has to be narrowed by suturs so that stomach will not migrate up again.
- The upper part of Stomach is freed from its blood vessels and wrapped all around the lower esophagus to form a new valve; It is sutured to Esophagus .
- This is called Nissen’s Fundoplication.
- Patient is put on liquid diet for one week and then slowly on Regular diet.
- Most patients will have dramatic relief from heartburn and other symptoms.
- Difficulty in swallowing
- Recurrence due to slippage of new valve into chest.