Abdomen is separated from chest by diaphragm which contains certain holes or openings through which oesophageous and aorta passes down to get attatched to stomach and heart. See diagram these opening on diaphragm on wikipedia. These holes are known as hiatus which literally means (a natural fissure in a structure).
Due to obesity, the fat deposits in hiatus causing it to become weak.
Old age also weakens the hiatus due to degenerative changes in muscles.
Some of time due to abdominal tumors, multiple pregnancy, pressure inside abdomen increases and pushes the organs towards chest.
All of the above factors causes the oesophagus & stomach to be pushed or pulled into thoracic cavity leading to disease known as HIATUS HERNIA.
Types of Hiatus Hernia: ( 3 types)
1. Sliding hernia
2. Rolling hernia: greater curvature of stomach ascends into a sac in mediastinum causing compression on heart and lungs.
3. Mixed hernia: which contain both rolling and sliding types.
Patient will complain of spigastric burning due to GERD.
Discomfort after a small meal.
Hiccough due to irritation of phrenic nerve
Surgical Correction of Hiatus Hernia.
1. Nissen’s total fundoplication: fundus of stomach is mobilized by cutting short gastric arteries and is brought behind the oesophagus wrapped around the oesophagus as shown in video below by nucleusanimations.
Mobilised fundus is wrapped and sutured in front of lower oesophagus, and diaphram is repaired by nylon or silk.
2. Belsey mark IV operation.
3. Posterior gastropexy or Hill’s repair or medial arcuate ligament repair.
In case of rolling hernia, sac should be reduced.
See the X-ray and MRI in 70 year old woman showing hiatus hernia