Reversing Hiatal Hernia With Manual Therapy: Does It Work?

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Evidence based

Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

Our team of licensed nutritionists and dietitians strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

Is Manual Therapy Effective at Reversing Hiatal Hernia? 

• Treating and Reversing Hiatal Hernia|
• Types of Manual Therapy|
• Lifestyle Changes for Symptom Treatment|
• When Is Surgery Recommended?|
• Understanding Hiatal Hernia|
• Causes of Hiatal Hernia|
• Living with Hiatal Hernia|

Key Takeaways

• There’s no natural treatment that will completely reverse the atypical anatomy that causes hiatal hernia (but there are techniques that can help).
• The most common symptom of hiatal hernia is reflux (GERD), and treatments that improve GERD often improve the symptoms of hiatal hernia.
• Manual self-adjustment of the abdominal area has shown improvements in hiatal hernia symptoms in clinical settings.
• Surgery to repair the abdominal abnormalities that cause hiatal hernias are used in cases of a large hernia and/or severe symptoms.

While there’s no proven way of naturally reversing hiatal hernia, there are some great non-surgical treatments that can help improve symptoms. 

A hiatal hernia is caused by abnormal anatomy, most often when the gastroesophageal junction protrudes up through the hiatus, which is an opening in the diaphragm located in the abdomen [1]. They can be congenital or acquired, meaning you may be born with it or you may have developed one over time. 

The most common symptoms of hiatal hernia are reflux, a burning sensation in the chest, and a feeling of being full even after a small meal. We’ll get into more details about hiatal hernia symptoms and causes in a bit. However, you’re most likely reading this article because you have been diagnosed with or suspect you have a hiatal hernia and you want to know how to improve your symptoms — so first, let’s talk about reversing hiatal hernia.

Treating and Reversing Hiatal Hernia

When examining how to treat a hiatal hernia, we want to look at the severity of symptoms. Many people have hernias and do not have symptoms (they’re asymptomatic). Generally, in conventional and functional medicine, if a person is asymptomatic, treatment is conservative and mostly involves lifestyle modifications. 

Severe cases with either a large hernia or intense symptoms aren’t as common, but in those cases surgery may be done, as it’s the only way of reversing hiatal hernia. 

Even in symptomatic cases, most treatments don’t involve surgery. Since most hernias are mild enough to not require surgery, let’s first take a look at some of the natural treatment options to improve symptoms [2].

Types of Manual Therapy

Manual therapy attempts to get the internal anatomy back into the right place through manual manipulation of the outside of the abdomen. There are a few different kinds of manual therapy, two of which are done by a practitioner and have some good research studies behind them. The other can be done on yourself and is a bit similar to the manual therapy done by a practitioner.  

While manual therapy often gets the internal anatomy lined up better, it’s not proven to reverse hiatal hernia, meaning it doesn’t seem to permanently fix the abnormal anatomy that causes hernias.

However, people do see a relief of symptoms. Let’s take a look at those forms of therapy now. 

Self-Adjustment Maneuver 

We’ve been using the self-adjustment maneuver in our clinic at the Ruscio Institute for Functional Medicine, with good success in some of our patients who were continuing to struggle with reflux and other gastrointestinal symptoms, even after diet and lifestyle changes. 

In fact, with one of our patients, while she had seen improvements with an anti-inflammatory diet and probiotics for her gut health, she was still experiencing acne, stomach pain, and reflux. Dr. Joe Mather, MD, medical director of the Ruscio Institute, had her try self-adjustment for a week and she started to feel a bit better. Then one day she noted that when she swallowed her food, it felt like everything suddenly came into alignment, indicating a possible realignment to improve the hernia. After that, she had continual improvement of her acne and gastrointestinal symptoms. 

In the podcast episode that discusses the above patient case, Dr. Joe notes: “I speculate that the vagus nerve can become compressed even in small hiatal hernias, leading to poor motility and constipation. I have now seen several cases where chronic constipation has significantly improved following this maneuver.”

Not only can these maneuvers possibly realign the anatomy of the gastroesophageal junction, but they may also help to regulate the vagus nerve. The vagus nerve travels from the base of the skull to the abdomen and it helps regulate digestion [3]. 

The self-adjustment maneuver, which you can watch on YouTube, involves applying pressure with the fingers in a downward motion to the area of the abdomen about one inch below the sternum and one inch to the left below the rib cage. This is approximately the area of the gastroesophageal junction (GEJ) and may help stop the GEJ from protruding through an opening in the diaphragm called the hiatus.  

Remember, we are not reversing a hiatal hernia and permanently fixing the anatomical abnormality, but rather creating better alignment. These maneuvers may need to be done periodically to keep things in good alignment.

If you try this maneuver to help resolve your symptoms, do it daily for a week and note any improvements in your symptoms. See if you can feel better alignment of your abdominal cavity. Everyone describes the feeling of food not traveling well from the esophagus to the stomach differently. An improvement of alignment may feel like less pressure when you eat, it is easier to swallow, or food doesn’t feel like it gets stuck anywhere in your system.

While we don’t have research studies on this particular self-adjustment maneuver, it’s based on research about other manual therapies. These other manual therapies are performed by healthcare practitioners in osteopathy and myofascial therapy. 

Osteopath Treatment

In osteopathic manual therapy, the physician applies pressure in the area below the sternum while the patient breathes in and bends forward. The patient then straightens their spine, extends their head back, and breathes out while the physician applies pressure downward. In one clinical trial, patients who received the osteopath treatment had significantly greater improvement in GERD symptoms compared to the control group [4]. 

In another trial, in a group of people who had GERD, those who received the manual therapy had a 9-27% increase in lower esophageal sphincter pressure as measured by manometry [5]. People with a hiatal hernia have a decrease in lower esophageal sphincter pressure, indicating that this maneuver may be beneficial for hiatal hernia, but it doesn’t prove that the maneuver resolves the anatomic abnormality of hiatal hernia. 

Myofascial Treatment

In myofascial therapy treatment of GERD, various manual techniques are used by a myofascial therapist around the abdomen to improve mobility of the diaphragm. These techniques, over the course of two weeks, with two treatments a week, resulted in improvement in GERD symptoms, gastrointestinal quality-of-life, and reduced proton pump inhibitor (PPI) use compared to the control group [6]. Again, this shows improved symptoms and the possibility that it may be improving the anatomical abnormalities of a hernia. 

While manual therapy options can help in the treatment of symptoms of hiatal hernia, there are also some lifestyle changes that have been shown to help treat GERD and thus people living with a hiatal hernia. 

Lifestyle Changes for Symptom Treatment

Because the most common symptom of hiatal hernia is acid reflux, treating GERD is the best way to improve the symptoms caused by hiatal hernia.

Below are some general lifestyle modifications that can help [2]:

• In patients for whom obesity is a contributing factor in exacerbating hiatal hernia due to intra-abdominal pressure, weight loss can significantly improve GERD symptoms [7].
• Elevating the head of the bed 8 inches during sleep can help keep contents of the stomach down.
• Avoiding meals two to three hours before bedtime, so that food is farther down in the digestive system before sleep, can be helpful to reduce acid reflux that may keep you awake.
• Eating several smaller meals throughout the day instead of large meals if you feel full quickly when eating.
• Eliminating common reflux trigger foods such as caffeine, chocolate, alcohol, spicy foods, citrus, and carbonated drinks may also be helpful.

Many of these lifestyle changes are typically suggested in conventional treatment, and at times surgery or medication is recommended.

When Is Surgery Recommended?

Surgery is the only way of reversing hiatal hernia and is typically reserved for severe symptoms or if a large hernia is found [8]. Fundoplication is a hiatal hernia surgery where part of the fundus of the stomach is wrapped around the base of the esophagus, which reinforces the sphincter to lessen the possibility of acid or food coming back through to the esophagus [1, 2, 9]. 

Most hiatal hernias fall into the less severe category, and in conventional medicine may be treated with medications to decrease stomach acid, such as proton pump inhibitors (PPI), h3 blockers, or antacids.

Understanding Hiatal Hernia

A hiatal hernia is when either the upper part of the stomach or another internal organ pokes through an opening in the diaphragm (muscle in the abdomen that assists with breathing) called the hiatus [1]. The hiatus is where the esophagus passes through to connect with the stomach.

It’s estimated that 10-50% of adults have a hiatal hernia [10]. Many of these hernias are small, do not cause any symptoms, and do not need to be surgically addressed.

If the hernia gets bigger, the most common symptom is reflux, or gastroesophageal reflux disease (GERD). In fact, hiatal hernias are the most common cause of GERD [1, 11]. This is because when the stomach pushes up through the diaphragm, this loosens the lower esophageal sphincter, allowing food and/or stomach acid to come back up into the esophagus, causing reflux. 

Most people are diagnosed with a hiatal hernia after looking into symptoms of reflux or chronic abdominal issues. Common symptoms of a hiatal hernia are heartburn or chest pain, pain above the belly button, feeling full soon after eating, chronic cough or clearing of the throat, asthma, and difficulty swallowing [1, 2].

Hiatal hernias are not usually diagnosed by physical examination. A few common diagnostic tests are endoscopy, barium swallow study, and esophagography. Treatment will depend on the severity of symptoms and severity of the hernia. 

There are four types of hernias: sliding type, paraesophageal, combination of paraesophageal and sliding, and type 4 — when the upper stomach and part of another abdominal organ protrudes into the chest cavity [1]. 

Sliding type is the most common, representing 95% of all hiatal hernias [1].

Type	Description
Type 1 (sliding type) Most common 95% of hiatal hernias are type 1	Occurs when the gastroesophageal junction (GEJ, where the esophagus meets the stomach) bulges upwards through the hiatus.
Type 2 (paraesophageal) Makes up about 5% of hiatal hernias	Occurs when the upper part of the stomach (fundus) protrudes through the diaphragm and into the area of the chest cavity between the lungs.
Type 3 (paraesophageal and sliding)	Occurs when both the GEJ and upper stomach bulge through the diaphragm, which is a combination of type 1 and 2.
Type 4	Occurs when the upper stomach and part of another abdominal organ (such as the intestines or spleen) protrudes into the chest cavity.

Causes of Hiatal Hernia

Hiatal hernia can be congenital (you’re born with it) or acquired over time [1]. A hiatal hernia may develop over time due to muscle weakness or laxity of the diaphragm as you age. The incidence of hernia increases as we get older, however only 9% of people with hiatal hernia have symptoms [1, 12]. 

Increased pressure in the abdomen from pregnancy, repeated heavy lifting, chronic constipation, chronic obstructive pulmonary disease (COPD), or obesity also increase risk [2, 13].

There may also be some genetic factors that contribute to laxity of the muscles, such as laxity of the phrenoesophageal ligament, that may lead to a hiatal hernia [9, 14]. We’ve noticed in observation of patients that hiatal hernia may be more common in people with hypermobility disorders such as Ehlers-Danlos syndrome. Hypermobility causes laxity of the muscles and tendons of the body.

We can’t avoid many of the potential causes of hiatal hernia, but living in a way that decreases intra-abdominal pressure, particularly keeping your weight lower, is one area where you do have some agency in your well-being. Various studies show the rates of hiatal hernia in people who are morbidly obese to be between 15-37% [15, 16, 17].

At our clinic, we usually start patients on an anti-inflammatory diet, such as a Paleo diet. This can not only help maintain a healthy weight for you, but also improve any gastrointestinal symptoms that might not only be caused by a hernia. Many gastrointestinal symptoms overlap and if you have issues with leaky gut, you may have symptoms of reflux that may not be due to a hernia. A Paleo diet is a great first step to improve your overall gastrointestinal health and may help if you also happen to have a hernia. 

Living With Hiatal Hernia

If you have symptoms of GERD, feelings of fullness quickly after eating, or indigestion, and/or you know or suspect you have a hiatal hernia, you may want to make some lifestyle changes to see if your health improves.

Because the main symptom of a hiatal hernia is acid reflux — but symptoms of reflux can also be caused by leaky gut or other general poor gut functioning — changing to a more gut-supportive diet for a month is a great first step to healing. 

You can also support feeling a bit better by trying a few of the simpler lifestyle changes, such as eating smaller meals, not eating within a few hours of going to bed, and elevating the head of your bed at night by 8 inches.

While surgery is the only way of reversing a hiatal hernia, you can also use the manual self-maneuver technique to see if it helps align your anatomy better. This may help relieve symptoms, especially if you’ve made dietary and lifestyle changes and are still struggling. 

If you have been dealing with chronic gastrointestinal symptoms and would like help making a plan to improve your health, we are here to help you at the Ruscio Institute for Functional Medicine. 

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

➕ References

1. Smith RE, Shahjehan RD. Hiatal Hernia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. PMID: 32965871.
2. Sfara A, Dumitrascu DL. The management of hiatal hernia: an update on diagnosis and treatment. Medicine and Pharmacy Reports. 2019 Oct 25;92(4):321–5. DOI: 10.15386/mpr-1323. PMID: 31750430. PMCID: PMC6853045.
3. Tindle J, Tadi P. Neuroanatomy, parasympathetic nervous system. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. PMID: 31985934.
4. Eguaras N, Rodríguez-López ES, Lopez-Dicastillo O, Franco-Sierra MÁ, Ricard F, Oliva-Pascual-Vaca Á. Effects of Osteopathic Visceral Treatment in Patients with Gastroesophageal Reflux: A Randomized Controlled Trial. J Clin Med. 2019 Oct 19;8(10). DOI: 10.3390/jcm8101738. PMID: 31635110. PMCID: PMC6832476.
5. da Silva RCV, de Sá CC, Pascual-Vaca ÁO, de Souza Fontes LH, Herbella Fernandes FAM, Dib RA, et al. Increase of lower esophageal sphincter pressure after osteopathic intervention on the diaphragm in patients with gastroesophageal reflux. Dis Esophagus. 2013 Jul;26(5):451–6. DOI: 10.1111/j.1442-2050.2012.01372.x. PMID: 22676647.
6. Martínez-Hurtado I, Arguisuelas MD, Almela-Notari P, Cortés X, Barrasa-Shaw A, Campos-González JC, et al. Effects of diaphragmatic myofascial release on gastroesophageal reflux disease: a preliminary randomized controlled trial. Sci Rep. 2019 May 13;9(1):7273. DOI: 10.1038/s41598-019-43799-y. PMID: 31086250. PMCID: PMC6513998.
7. Singh M, Lee J, Gupta N, Gaddam S, Smith BK, Wani SB, et al. Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: a prospective intervention trial. Obesity (Silver Spring). 2013 Feb;21(2):284–90. DOI: 10.1002/oby.20279. PMID: 23532991. PMCID: PMC3853378.
8. Rosen RD, Winters R. Physiology, lower esophageal sphincter. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 32491384.
9. Watson TJ, Moritz T. Hernia, Sliding (Paraesophageal). In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2017. PMID: 29083633.
10. Scarpato E, D’Armiento M, Martinelli M, Mancusi V, Campione S, Alessandrella A, et al. Impact of hiatal hernia on pediatric dyspeptic symptoms. J Pediatr Gastroenterol Nutr. 2014 Dec;59(6):795–8. DOI: 10.1097/MPG.0000000000000536. PMID: 25141229.
11. Kahrilas PJ, Kim HC, Pandolfino JE. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol. 2008;22(4):601–16. DOI: 10.1016/j.bpg.2007.12.007. PMID: 18656819. PMCID: PMC2548324.
12. Hyun JJ, Bak Y-T. Clinical significance of hiatal hernia. Gut Liver. 2011 Sep;5(3):267–77. DOI: 10.5009/gnl.2011.5.3.267. PMID: 21927653. PMCID: PMC3166665.
13. Menon S, Trudgill N. Risk factors in the aetiology of hiatus hernia: a meta-analysis. Eur J Gastroenterol Hepatol. 2011 Feb 1;23(2):133–8. DOI: 10.1097/MEG.0b013e3283426f57. PMID: 21178776.
14. von Diemen V, Trindade EN, Trindade MRM. Hiatal hernia and gastroesophageal reflux: Study of collagen in the phrenoesophageal ligament. Surg Endosc. 2016 Nov;30(11):5091–8. DOI: 10.1007/s00464-016-4858-1. PMID: 27005292.
15. Che F, Nguyen B, Cohen A, Nguyen NT. Prevalence of hiatal hernia in the morbidly obese. Surg Obes Relat Dis. 2013 Dec;9(6):920–4. DOI: 10.1016/j.soard.2013.03.013. PMID: 23810611.
16. Assakran BS, Alrakbi K, Alharbi MA, Almatroudi MA, Alshowaiman A, Alromaih AH, et al. Prevalence of asymptomatic hiatal hernia in obese patients during preoperative upper gastrointestinal endoscopy assessments and correlation with body mass index. Cureus. 2021 Feb 17;13(2):e13396. DOI: 10.7759/cureus.13396. PMID: 33758697. PMCID: PMC7978160.
17. Pandolfino JE, El-Serag HB, Zhang Q, Shah N, Ghosh SK, Kahrilas PJ. Obesity: a challenge to esophagogastric junction integrity. Gastroenterology. 2006 Mar;130(3):639–49. DOI: 10.1053/j.gastro.2005.12.016. PMID: 16530504.

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10 Remedies That Can Cure Hiatal Hernia Naturally

Hiatal hernia is the most common type of diaphragmatic hernia. The hernia occurs when a part of the stomach pushes through the hiatus (part of the digestive system that connects stomach to the esophagus).

With the right lifestyle changes and simple home remedies, hiatal hernia can be curbed. Some of them are discussed below.

Table of Contents

1. Self-massage

A simple self-massage can help get relief from the symptoms of hiatal hernia. This works on the uppermost portion of the abdominal cavity. This not only helps to reduce the discomfort and symptoms of hernia but also strengthens the abdominal muscles.

You can self massage the herniated area twice daily. To properly massage the hernia, follow the below-mentioned instructions-

1. Start by relaxing and lying on your back.
2. Try to find your rib cage with your fingers just below the breast bones.
3. Slowly apply pressure in the downward direction towards the belly button.
4. Massage the area for at least 5 minutes.

2. Try the Warm Water Fix

Just after waking up in the morning, while you are still in bed, drink a glass of lukewarm or room temperature water. This helps to relax the abdominal muscles and the diaphragm, therefore, bringing down the hernia from opening in the diaphragm.

After drinking a glass of warm water, try the following exercises-

1. Rise quickly up and down on your toes and heels a couple of times. This helps to pull the weight of the water down.
2. Raise your arms up and take a few short quick breaths with your mouth open for 15 seconds. This exercise helps to tighten the diaphragm back up and close the hole.

Also Read: Difference between Hiatal Hernia and GERD

3. Use Apple Cider Vinegar

Known for its acidic nature, ironically it produces an alkaline effect in the body. The anti inflammatory properties of apple cider vinegar treats the symptoms of hiatal hernia including inflammation in the stomach, heartburn and acidity.

In a glass of warm water, add a few drops of raw apple cider vinegar. Drink this everyday just before meals.

4. Take Cinnamon

One of the major components of cinnamon, Cinnamaldehyde, helps to alleviate the symptoms of gastric inflammation. Therefore, it can also help get relief from acid reflux which is a common problem associated with a hiatal hernia.

You can take a half teaspoon of cinnamon powder in a glass of warm water. Drink this mixture twice a day to get the best results.

5. Yoga for Hiatal Hernia

Yoga is the safest method to close an opening caused by a hiatal hernia.  However, not all poses should be practiced or else it can make the condition worse.

The poses that strengthen the diaphragm and the stomach muscles should be practiced while yoga postures that put extra pressure on the abdomen such as Cobra, Bow, and Bridge pose should be avoided.

6. Drink Chamomile Tea

Apart from getting relief from symptoms of hiatal hernia, chamomile tea can cure different types of gastrointestinal problems. This helps to manage acidity which is one of the most common symptoms of hiatal hernia. Chamomile tea is rich in anti-inflammatory properties.

Drinking chamomile tea can effectively lower gastric acidity as well as inhibit secondary hyperacidity.

In a cup of water, add a teaspoon of chamomile tea and boil it for 5 minutes. Strain the mixture and drink the tea.

7. Drink Slippery Elm Tea

Slippery Elm tea is rich in gastroprotective effects. Hence, this reduces stomach acidity and helps to get relief from heartburn. This has a soothing, anti-inflammatory effect on the body.

Mix two teaspoons of slippery elm powder in a glass of hot water and drink it to get soothe out symptoms such as acid reflux or heartburn.

8. Change Your Daily Diet

As the hiatal hernia occurs in the abdomen, the main problem it causes is related to digestive problems. Thus, it becomes necessary for a patient with hiatal hernia to keep a close eye on their diet.

There is a particular set of food that should be eaten as well as avoided.

Food to eat by people suffering from hiatal hernias

For a person with hiatal hernias, non-acidic food that contains dietary fiber is quite beneficial.  Some of the foods that are safe to eat are-

1. Green vegetables
2. Beans and peas
3. Lean protein such as fish and chicken
4. Non-citrus fruits and juices
5. Nuts and seeds
6. Artichoke and asparagus
7. Cardamom
8. Coriander
9. De-caffeinated drinks such as ginger, dandelion and green teas
10. Healthy fats such as  coconut, avocado, and olive oil
11. Broth
12. Fermented foods that are rich in probiotics

Food to avoid  during Hiatal Hernia

Patients of hiatal hernia should avoid acidic, rich, oil and preservative-rich food. This will help to reduce heartburn, gas, indigestion, bloating or reflux.

1. Fatty foods
2. Caffeinated drinks
3. Fried/oily food
4. Cocoa and chocolate
5. Alcohol
6. Tomato sauces
7. Candies
8. Soft drinks and carbonated beverages
9. Sweetened juice or tea
10. High-fat dairy products
11. Food with high salt content
12. Cereals and bread
13. Fast food
14. Garlic, shallots, onions, leeks, and chives

9. De-stress

Chronic stress is a major factor why people develop hiatal hernias. When stress occurs too often or stays too long in the body, these changes can cause a malfunction in the body and lead to displacement such as a hernia.

Meditate or pray a few minutes on a daily basis to ease out the anxiety. Laugh your heart or dance to your favorite music to increase the production of endorphin which decreases stress levels.

10. Stay Hydrated Throughout the Day

It is important for hiatal hernia patients to maintain optimal hydration throughout the day. Drinking water outside the meal times makes sure that the digestive juices are not diluted nor digestion is inhibited. A basic guideline to keep in mind is avoiding drinking an hour before and after meals.

Read more: How to cure an inguinal hernia without surgery?

Pristyn Care Recommends

Women who have had multiple pregnancies or people who are obese or overweight are more likely to develop a hiatal hernia. Also, people who consume a lot of fatty foods have higher chances of suffering from a hernia.

The natural remedies can only help in easing out the discomfort associated with hernia. Also, these remedies cannot be tried on infants who have developed a hernia.

Curing a hernia with the natural method may not always prove to be fruitful. Meanwhile, delaying the right treatment option can complicate the condition and even lead to strangulation.

Strangulation can turn out to be fatal for people suffering from hiatal hernia. Pristyn Care recommends patients to consult with a doctor as soon as they experience symptoms of a hiatal hernia.

The most effective treatment option for curing a hiatal hernia is laparoscopic hernia repair. In this procedure, the doctor uses a special instrument- a laparoscope- to navigate inside the abdomen and strengthens the weakened area with a surgical mesh. Furthermore, the success rate of this procedure is also very high.

Also Read:

• Things To Do and Avoid During Hernia
• 15 Life Saving Facts About Inguinal Hernia
• Difference Between Direct And Indirect Hernia

FAQ’s

Q. Can you reverse a hiatal hernia?

A. All hernias are irreversible in nature. The reason being that there is an opening in the abdomen, through which the part of tissue slides. To cure a hernia, the opening needs to be closed.

Q. Can you eat eggs with hiatal hernia?

A. Protein-rich foods such as eggs, legumes, etc. are recommended to people suffering from hiatal hernia. Also, eat lean meats and fish, fiber-rich diet along with lots of water.

Q. Is it possible to fix a hiatal hernia without surgery?

A. Any type of hernias cannot be treated without surgery. In initial stages, the doctor can recommend watchful waiting. However, it can become serious and be life-threatening.

Diaphragmatic hernia

Diaphragmatic hernia

general information

For patients, all cases of diaphragmatic hernias can be divided into safe and potentially dangerous variants. The safe option is most often represented by sliding hiatal hernias. Dangerous hernias include defects in the diaphragm through which it is dangerous by infringement or when large volumes of the contents of the abdominal cavity move into the chest. Safe hernias require observation and only in some cases surgical treatment. Dangerous diaphragmatic hernias need to be operated on immediately.

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What is the danger of a sliding hernia of the esophageal opening of the diaphragm.

Diaphragmatic hernia itself is harmless in most cases. However, diaphragmatic hernia can contribute to the development of the reflux of stomach contents into the lumen of the esophagus – gastroesophageal (gastroesophageal reflux). Gastroesophageal reflux disease (GERD, GERD) develops.

Prolonged exposure to acid (from the stomach) or alkaline (from the duodenum) reflux on the esophagus leads first to inflammatory changes (esophagitis), then to changes in epithelial cells (metaplasia – Barrett’s esophagus), and then to cancer of the esophagus.

How often do we see diaphragmatic hernia GERD

Hiatus hernia (HH) and gastroesophageal reflux disease (GERD) are common diseases in gastroenterology and often require surgical treatment. According to the survey, the presence of symptoms of gastroesophageal reflux is detected in 30-40% of the population, and up to 25% of patients in this group need constant medication, and up to 15% – exclusively in surgical treatment.

Endovideosurgical interventions for gastroesophageal reflux disease and hiatal hernia.

The area of ​​the esophageal-gastric junction is considered to be anatomically “uncomfortable”, therefore, in traditional antireflux surgery, adequate access is a key issue.

Over the past century, surgical techniques have improved. Domestic surgeons Yu.E. Berezov, B.V. Petrovsky, N.N. Kanshin, A.F. Chernousov, A.I. this branch of surgery.

The main disadvantages of open operations are a significant traumatic effect on tissues, severe pain in the postoperative period, as well as infectious complications from surgical wounds and the formation of postoperative hernias. Regardless of the constitution of the patient, an extended median laparotomy, often with the removal of the xiphoid process, is necessary to ensure free access to the diaphragmatic pedicles, esophagus, and gastric fundus.

A new stage and rise in the treatment of HH and GERD is associated with the development and implementation of EVH technologies in clinical practice.

In 1991, Nathanaon, Cuschieri, and Shimi reported the first laparoscopic anti-reflux surgery, round ligament gastropexy. In the same year, B.Dallemagne (Belgium) and T.Geagea (Canada) performed the first Nissen laparoscopic operation.

Since 2000, in a number of countries, among laparoscopic interventions on the abdominal organs, antireflux operations have become second only to cholecystectomy in frequency.

Today, endovideosurgical antireflux operations are widely used in the world and are the method of choice.

The main advantages of laparoscopic access are: good visualization of the intervention area; ease of manipulation in the area of ​​the esophageal-gastric junction; low invasiveness, which determines the absence of a pronounced pain syndrome in the early postoperative period; low percentage of postoperative hernia formation; good cosmetic effect; economic benefit associated with a reduction in the duration of hospitalization and the consumption of medicines and dressings

Indications for endovideosurgical interventions for GERD and HH are:

To date, indications for surgical treatment of GER have been formulated. Some of them require clarification and further justification.

1. Lack of effect from conservative treatment.

2. Progression of the disease, despite the maximum dose of drugs. According to statistics, in 40% of patients in this group, continued drug treatment leads to the development of complications in the form of ulceration, stricture and secondary shortening of the esophagus over the next 5 years, and the risk of subsequent surgical treatment increases dramatically. Therefore, patients in this group should be operated on as soon as possible.

3. The need for long-term and intensive drug treatment. Young patients suffering from gastroesophageal reflux, the presence of which is confirmed during the examination, are ideal candidates for surgical treatment. Coley et al. proved to significantly reduce the cost and improve the results of treatment with a surgical approach in a group of patients younger than 49 years.

4. The patient’s unwillingness to carry out long-term drug treatment due to the high cost of the latter, the inconvenience or danger of side effects.

5. Non-compliance by the patient with the regimen of drug treatment.

6. Esophagitis of 3-4 degrees, which persists after repeated long courses of conservative treatment, in case of alternating acid and alkaline reflux. It has been proven that taking antisecretory drugs in this group of patients is ineffective.

7. Moderately pronounced esophagitis (1-2 degrees) in patients with signs of mechanical insufficiency of the cardia and frequent episodes of GER.

8. The presence of an axial hernia of the esophageal opening of the diaphragm with gastroesophageal reflux (usually refractory to drug treatment).

9. Paraesophageal HH, even without signs of GER.

10. Complicated course of GER, including the formation of ulcers, strictures of the esophagus, Barrett’s esophagus, severe pulmonary complications. This group clearly demonstrates the benefits of surgical treatment of GER, which allows patients to return to a normal quality of life without the need for further medication. In case of strictures of the esophagus, the need for dilatation of the cardia after antireflux surgery is reduced fivefold, and extraesophageal, including pulmonary manifestations of GER are stopped

11. Severe respiratory manifestations of GER, such as aspiration, frequent pneumonia, chronic laryngitis. Only 50% of patients in this group present with chest pain, heartburn, or endoscopic findings. However, a comprehensive examination using modern methods can confirm the presence of gastroesophageal reflux.

12. Concomitant diseases of the abdominal cavity requiring surgical intervention.

Indications for surgical treatment of GERD can be somewhat expanded using endovideosurgery, as a less traumatic intervention with a relatively low risk.

The main contraindications to laparoscopic interventions should be considered: severe cardiovascular disorders; respiratory failure; disorders of the blood coagulation system; late pregnancy; previous operations on the upper floor of the abdominal cavity.

Methods of surgical treatment for sliding hernias of the esophageal opening of the diaphragm

Currently, there are several methods of laparoscopic antireflux operations, however, Nissen, Dor and Toupet methods are mentioned and analyzed in the literature as the most commonly used.

The choice of the method of surgical support depends on the nature of the underlying and concomitant diseases, the preference of the surgeon, and remains one of the most discussed problems in this section of surgery. As a rule, the fundoplication is supplemented with an anterior or posterior crurorrhaphy. In pediatric practice, synthetic prostheses are sometimes used to replace large hernial defects.

Results of treatment of diaphragmatic hernias (laparoscopic fundoplications).

Our clinic has the experience of 238 anti-reflux surgeries using endovideosurgical technologies.

To correct the function of the gastroesophageal junction, we performed the following types of EVC fundoplications: by the Nissen method 15 (6. 3%), by the Toupet method – 35 (14.7%), by the Dor method 188 (79%).

The average duration of EVH antireflux surgery is 70-90 minutes and depends on the method of fundoplication.

Intraoperative complications were noted in 5 (2.4%) patients (esophageal perforation – 1, spleen injury – 1, pleura injury – 1, bleeding from the crus of the diaphragm – 2). Only in 1 case of esophageal perforation, access conversion was required to eliminate the complication.

In the first two days of the postoperative period, the patient can drink. On the third day after the operation, liquid food is allowed, on the fourth – soft food. The patient switches to a normal diet with the use of solid food (bread, hard fruits, vegetables, etc.) from the 6th week after the operation.

Painkillers in the immediate postoperative period are used as needed.

In our experience, in the absence of complications, most patients can be discharged from the hospital 3-4 days after surgery.

In the postoperative period, we studied the results of treatment at 1 and 6 months after surgery.

Subjectively, in the immediate postoperative period, 8 (3.9%) patients had short-term dysphagia, which spontaneously stopped by the time the patients were discharged and was probably associated with postoperative edema in the intervention area.

After the Nissen operation, one patient developed signs of impaired swallowing of solid food, pain in the epigastrium. An endoscopic examination revealed a narrowing of the lumen of the esophagus in the region of the LES, which made it difficult to carry out the endoscope, due to the increased pressure of the fundoplication cuff. The patient underwent two courses of endoscopic bougienage with a positive effect.

In one elderly patient, a month after the Dor fundoplication, signs of severe gastroesophageal reflux appeared simultaneously with cholecystectomy. X-ray examination of the patient revealed a recurrence of hernia of the esophageal opening of the diaphragm. Therefore, the result of treatment is considered unsatisfactory.

In other cases, good results of treatment were noted, patients did not need additional medical treatment, signs of hernia of the esophageal opening of the diaphragm or insufficiency of the cardiac sphincter were not observed during X-ray and endoscopic examination.

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Keywords:

diaphragmatic hernia

hiatal hernia treatment

diaphragmatic hernia

esophageal diverticula

abdominal hernia

foreign bodies of the esophagus

GERD

gastroesophageal reflux disease

achalasia cardia

cost of treatment

new methods

forum discussion

laparoscopy

Testimonials from K.

Puchkov’s patients operated on for hiatal hernia.

06/22/2020 13:44:00
Tsukanova Natalia

Congratulations to Professor Konstantin Viktorovich Puchkov and the entire staff of the Swiss University Clinic on their professional holiday – Medical Worker’s Day. Thank you, dear colleagues (I am a doctor myself), for your hard and invaluable work: you help people restore their health, and sometimes save their lives. Low bow to you!!!
I am infinitely grateful to Konstantin Viktorovich for the successful operation on 03/16/20 for my HH. I got rid of a long-term problem and found a full life. Many specialized clinics refused me an operation, citing my advanced age, I am 74 years old, the presence of chronic concomitant diseases, large hernias and the age of the process. At best, they did not guarantee a positive result. Prof. Puchkov, having familiarized himself with the anamnesis, with my analyzes, examinations, without hesitation, agreed.
I have read a book by prof. Puchkova “How to become a successful surgeon and remain so all my life” in one breath, with great interest, and she made an indelible impression on me. Many have not read this book, and I want to tell people who have health problems about an outstanding surgeon, a wonderful person, Professor Konstantin Viktorovich Puchkov. I admire his high professionalism. He has deep knowledge, vast experience and creative skills. He is a talented, first-class surgeon. The operation that K.V. Puchkov performed on me, right?
has been worked for a long time by a French surgeon, but only for open abdominal operations. Prof. K.V. Puchkov was the first to perform this operation in a laparoscopic approach. He developed the surgical technique himself, proved its excellent efficiency and received a patent for this invention. Puchkov individually, sometimes not standard, approaches the treatment of each patient and chooses the method and volume of the operation that will be optimal for him. K.V. Puchkov owns many related specialties and successfully operates in general surgery, urology, and gynecology,
in both coloproctology and plastic surgery. This allows him to perform simultaneously (simultaneously) up to 5 operations on various organs with combined diseases of the abdominal cavity, small pelvis and retroperitoneal space. KV Puchkov loves his profession, is devoted to it. This is his calling. The purpose of his life, as I understood from the book I read, is to achieve excellence, to be the best in my
profession, not to stop there, to go forward, constantly improving. He uses the latest, advanced methods of treatment, including those developed by himself.
K.V. Puchkov loves not only his work, but also loves people whom he has faithfully served for decades. Despite the very busy schedule of work (from morning until late at night, operations, bypasses and consultations between them), he finds time to talk with the patient, calm him down before the operation, inspire confidence in the success of the operation, evoking a feeling of trust and peace in the patient’s soul.
KV Puchkov has charisma. He radiates calmness, confidence in himself and in his work, high responsibility towards patients, self-control, purposefulness, goodwill towards people, great diligence. He helps many people to restore health and a full life. This is the meaning and purpose of his whole life. Patients come to him from all over the country, as well as from other countries. He has great authority and recognition in our country and abroad. He speaks at Russian and foreign congresses, conducts a master class
sy with demonstrative operations both in Russia and in the West, publishes many scientific papers. monographs, has a scientific title: doctor of medical sciences. He has performed tens of thousands of laparoscopic operations, including those developed by himself, protected by patents. He is rightfully considered one of the best surgeons in the world in the field of laparoscopic surgery, urology, coloproctology, gynecology, oncology. .He was awarded the honorary badge “Golden Laparoscope.”
I am proud that we have such a surgeon as Konstantin Viktorovich Puchkov. I will recommend him, in case of health problems, to my relatives, friends, acquaintances. He will not leave you in trouble and will always come to the rescue.