What is hiatal hernia or reflux disease?
In humans, there is a valve between the esophagus and the stomach that prevents the food in the stomach from leaking back. During the chewing process, this valve opens and allows food to pass from the esophagus to the stomach. This cover prevents excessive weight gain, alcohol, excessive fatty foods, etc. It weakens due to factors such as and a closure defect develops. In this case, acid and food released from the stomach for the digestion of food rebound towards the esophagus and cause reflux disease. Over time, this may cause the normal cells in the esophagus to change shape and turn into malignant, that is, tumor cells.
How common is hiatal hernia or reflux disease?
Hatal hernia or reflux disease is seen in approximately 30-40% of the population. It is known that approximately 10% of the society uses antacid stomach medication.
What are the symptoms of reflux disease?
Reflux disease usually manifests itself with symptoms such as excessive burping, back pain, indigestion, bitter and sour water coming into the mouth, bad odor in the mouth, and a burning sensation in the throat. In some patients; It may also cause symptoms such as asthma, chronic sinusitis, hoarseness, vomiting, feeling of suffocation at night and excessive drooling. With the backflow of stomach acid into the esophagus, these patients often complain of sore throat, and with the preliminary diagnosis of "chronic pharyngitis", they are reported to Ear, Nose and Throat Diseases physicians for chest pain, palpitations, etc. It is observed that they consult Cardiology, Internal Medicine and Chest Diseases specialists with their complaints and therefore they may receive different treatments.
Can a hiatal hernia be visible from the outside?
Hatal hernia internal organs Since it is a concerning problem, it cannot be seen with the naked eye like umbilical, groin, and thigh hernias.
How is a stomach hernia diagnosed?
The diagnosis of hiatal hernia is often made by examining these areas with the help of a lighted instrument made of a special material called endoscopy (in the form of a hose) or by giving a medicated substance to the esophagus, stomach and duodenum� It is determined by taking a preliminary x-ray. Giving medication to the patient without performing these tests causes the diagnosis to be delayed and thus the patient to start appropriate treatment late. Heart diseases, liver and gallbladder diseases can also cause the same complaints.
What are the factors that facilitate the formation of reflux disease?
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Medical conditions: overweight (obesity)and pregnancy
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Personal habits: Alcohol and smoking p>
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Foods: Chocolate, coffee, mint, fatty foods, carbonated drinks (cola, soda, soda, mineral water, beer, etc.), milk, citrus fruits such as lemon, orange and grapefruit, hot, spicy and fried foods
How is the treatment of hiatal hernia?
Changes in lifestyle
Raising the head of your bed is beneficial. Elevating with pillows is not enough; instead, fully elevating the head of the bed is beneficial.
Changes in nutrition: Avoid the foods that facilitate reflux mentioned above. Arrange your meals small and frequent (try eating 4-5 meals a day instead of 3, but by reducing the portions).
Avoid smoking.
Losing weight; It is known that intra-abdominal pressure increases with excess weight and can exceed the gastric valve pressure at rest.
Do not bend over or lie down after meals, do not bend over to pick up an item or tie your shoes for 1 hour.
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Do not forget that any kind of STRESS will increase your stomach problems.
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The treatment of hiatal hernia is primarily done with various medications, thus trying to prevent the damage caused by stomach acid. In cases where there are some changes in the cells of patients who have not received treatment for many years, or the patient has a large hernia detected by endoscopy or x-ray, or does not respond to drug treatment, surgery is recommended for patients. S For decades, this surgery has been performed laparoscopically (popularly called bloodless surgery, which repairs the hernia without cutting the patient's abdomen with the help of a telescope and various tools). It is observed that the complaints of the patients disappear almost completely after the surgical intervention performed with the appropriate technique.
Although gastroesophageal reflux disease is seen in 30-40%in the society, only 30%< of these patients. /strong> will have to take medication for the rest of his life. Considering the side effects and cost problems of continuous medication use, laparoscopic reflux surgery is accepted as the only alternative that provides permanent treatment in this patient group. Today, the success rate with laparoscopic and robotic surgery is over 90%. The cells of the esophagus turn into cells called Barrett cells after intense bile contact. Barrett's cells may develop into Barrett's metaplasia, which is a pre-cancerous stage, and then Barrett's cancer. Only 10% of reflux patients have a condition called Barrett's esophagus, and an average of 5% of these patients have a precancerous change called dysplasia.
ENDOSCOPIC TREATMENT
Stretta method: It is an attempt to restore the relaxed muscle structure under the esophagus, which causes reflux disease, to its former function by giving radiofrequency waves with the help of gastroscopy. The Stretta method is applied to patients with valve opening less than 3 cm. Before the Stretta procedure, the patient is given a mild sedative. Then, through gastroscopy, radiofrequency waves are delivered to the lower part of the esophagus and the entrance to the stomach with the help of some special needles. During this procedure, the patient does not feel pain because the esophagus and stomach are insensitive to pain. The procedure takes about half an hour and patients can return home the same day. With the Stretta method, 60-70% of patients can get rid of constant medication use.
Özofix method: Özofix is a device that is inserted into the stomach together with the oral endoscope. The tip of the tool has the ability to bend and stitch. Özofix method is suitable for patients with valve opening less than 3 cm. is applied. Fundoplication, which is a surgical procedure to prevent reflux, can be performed endoscopically with this device. The procedure takes approximately 45 minutes and the patient is discharged on the same day or the next day. With the Özofix method, 60-70% of patients can get rid of constant medication use. Reflux treatment with the Özofix method can be applied in appropriate and selected cases. This method is not suitable for those with large stomach hernias and those with severe chemical burns in the esophagus (esophagitis).
SURGICAL TREATMENT
Rudolph Nissen was the first to perform funduplication surgery. He realized it in 1955. Nissen later worked in our country for a period of time, allowing the technique to develop in our country. The basis of the technique is to loosen the ligaments of a part of the stomach that forms a pocket at the entrance called the fundus, then rotate it 360o around the axis of the lower end of the esophagus and attach a natural ring or bracelet to the lower end of the esophagus. In the late 1980s, the use of laparoscopy in gallbladder surgeries became widespread, and over time, laparoscopy became the standard operating method in the surgical treatment of reflux disease, as in many other diseases. Regarding funduplication, Dor, Toupet etc. Although there are many different methods, Nissen fundoplication is the only repair method that has become the standard treatment worldwide.
Surgery for hiatal hernia or reflux disease; People who have to take medication constantly, whose complaints recur when they stop taking the medication, whose wounds or ulcers in the esophagus do not heal despite the medication, or whose wounds in the esophagus reopen immediately after stopping the medication, who have bleeding wounds in the esophagus, who develop advanced cellular changes on the surface of the esophagus, and especially young people. It is recommended for patients in the age group. Today, in the United States statistics, reflux surgery is among the laparoscopic surgeries; It comes in third place after gallbladder and obesity surgery. The permanent treatment method for reflux disease, whose long-term results are known today, is laparoscopic or robotic surgery. In cases where a wound occurs in the esophagus after reflux, hiatal hernia is diagnosed by endoscopy, and valve insufficiency, the patient may need to take medication for life. Action In the preoperative period, appropriate patient selection is one of the most important factors in achieving successful results. Here, 24-hour pH monitoring (a probe or tip that measures pH is placed in the esophagus and measurements are made for a day) or esophageal manometry tests are used. If the esophagus does not move food quickly enough, Nissen fundoplication surgery may not be suitable for the patient.
What are the advantages of laparoscopic hiatal hernia or reflux surgery?
- Post-surgery less pain
- Shorter hospital stay
- Quick return to work
- Better cosmetic result
How to prepare for laparoscopic hiatal hernia surgery?
Your doctor will tell you about the requirements for the surgery.
The necessary tests for the surgery will be performed.
It is useful to shower the night before the surgery.
After the surgery. You should stop eating and drinking as of midnight
Blood thinners and rheumatism medications such as aspirin and coumadin should be stopped 5-7 days before the surgery due to the risk of bleeding.
If diet medications are used, they should be stopped two weeks before the surgery.
It is beneficial for smokers to quit before the surgery.
How does laparoscopic hiatal hernia surgery proceed?
You go to the hospital on the morning of the day you will have the surgery.
After being greeted by the hospital officials. A thin catheter will then be inserted into your vein. Sedating medications will then be given through this catheter in preparation for the surgery.
During the surgery, you will be under general anesthesia (narcosis) for a few hours and will return to your room awake following the surgery. You will be taken.
Several holes of ½ cm to 1 cm are made on the abdomen and pipes where laparoscopy instruments called ports or trocars will be placed are placed. Expand the abdominal cavity by injecting carbon dioxide gas
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