Diagnosis diaphragmatic hernia

A diaphragmatic hernia can be diagnosed by means of a gastroscopy or an x-ray with gulp swallowing (a procedure in which the patient swallows porridge containing a contrast medium) in the low position of the head and abdominal press.

Therapy

Axial hiatal hernia (axial diaphragmatic hernia) is only treated with medication, usually with proton pump inhibitors, in cases of complaints such as reflux/heatburning. These reduce the acid formation in the stomach. The paraesophageal hernia as well as the mixed form is an indication for surgery even without clinical symptoms because of the potentially life-threatening risk of complications.

The surgical procedure is a so-called transabdominal gastropexy, whereby the stomach is completely returned to the abdominal cavity and finally fixed to the abdominal wall. In some cases, treatment can be conservative, i.e. surgery is not necessary at first and the patient waits and observes. This is mainly done when the diaphragmatic hernia does not cause any major discomfort.

In case of health problems a hernia surgery must be performed. There are different surgical techniques that are used today for a hernia treatment.

LaparoscopyToday, diaphragm surgery is usually performed laparoscopically, i.e.
a large abdominal incision as it used to be performed in the past is only necessary in exceptional cases, e.g. if visibility is too poor under the keyhole technique or if the anatomical conditions do not permit laparoscopic surgery. In laparoscopic surgery of a diaphragmatic hernia, 2-3 small incisions are made in the upper abdomen, through which instruments are then inserted into the abdomen. A camera, which transmits the surgeon’s view to a monitor, is also used additionally.
GastropexyIt is also possible to fix the stomach to the front abdominal wall.
This measure is called gastropexy and prevents the stomach from changing its position. The duration of this operation, which is very common in general surgery today, is between 30 minutes and 1.5 hours.

Decisive for the duration of the operation are the access, the visibility, the chosen surgical technique and the condition of the patient. For example, an operation on an overweight patient, who also has many concomitant diseases, would take longer than on a young athletic person.

The keyhole surgery usually takes a little longer than the open abdomen surgery but in any case has a better cosmetic result at the end. Both surgical procedures have the same success rate.Sometimes it can also happen that the surgeon starts the procedure with a minimal surgical technique, but then switches to an open surgical technique for reasons of visibility or complications. The most common problem with a diaphragmatic hernia is that the stomach slips through the hernial orifice.

In hernia surgery, the hernial orifice can be narrowed so that the stomach can no longer slide upwards. However, a kind of cuff formed by parts of the esophagus can also be placed around the neck of the stomach. This spreads the upper part of the stomach, which also prevents the stomach from sliding up.

This surgical measure is also called fundoplication and is today the most successful surgical technique for treating reflux disease. Since a diaphragmatic hernia can always be accompanied by a reflux, this surgical technique is often preferred. The operation of a diaphragmatic hernia is always performed under general anesthesia.

After the operation, the patient is placed on the monitoring ward for a short time, after which he is transferred to the normal ward. Afterwards the patient should be put on sick leave for 1-2 weeks. Depending on the job, the patient has to take care not to lift heavy weights for the next 4-6 weeks. In addition, no sports should be done for the next 14 days. The abdominal press should also not be used too much during this time.