Diaphragmatic hernia

Correction of a diaphragmatic hernia in Israel is successfully carried out in the surgical department of the private clinic at Herzliya Medical Center. The use of innovative laparoscopic surgery techniques allowed hospital specialists to minimize the risk of postoperative complications, as well as the duration of inpatient treatment.

What is a diaphragmatic hernia?

The diaphragm is a domed muscular structure that separates the chest cavity from the abdominal cavity. In addition to the barrier function, the muscles of the diaphragm play an important role in the process of breathing. In the diaphragm there are a number of holes allowing the organs of the digestive and circulatory systems to penetrate from the cavity of the thorax into the abdominal cavity. The muscle tissue around these openings is a relatively weak link in the organ, which often causes abnormal enlargement and insufficiency of the barrier function, called the diaphragmatic hernia or hiatal hernia.

 Types of a diaphragmatic hernia

One of the frequent manifestations of a diaphragmatic hernia is the hernia of the esophageal opening of the diaphragm – the place of penetration of the esophagus into the abdominal cavity. Small hernias impede the normal functioning of the esophageal-gastric sphincter, being the main cause of reflux (return of stomach contents to the esophagus). Large hernia of the esophageal aperture of the diaphragm can cause abnormal penetration of the abdominal cavity organs into the thorax with serious functional impairment and severe symptoms.

In clinical practice, the following types of a diaphragmatic hernia are most common:

• Sliding hiatal hernia. This type of hernia of the esophagus is observed in 70-80% of cases. The weakness of the ring of the esophageal opening leads to a free displacement of the posterior-upper part of the stomach, not covered by the peritoneum, into the cavity of the thorax. In the overwhelming majority of cases, the stomach returns unhindered to the abdominal cavity, which is the reason for the name of this pathology. Sliding diaphragmatic hernia is not infringed, and, as a rule, accompanied by gastroesophageal reflux, as well as secondary changes in the mucosa of the esophagus (reflux esophagitis)
• Para-esophageal hiatal hernia is characterized by a defect to the left of the esophagus, usually not exceeding 10 centimeters. The resulting hernial sac is covered from the abdomen by the peritoneum, which eventually undergoes pronounced fibrous changes. Unlike a sliding hernia, the upper part of the stomach remains fixed, whereas the hernial sac may contain part of the body of the stomach or other organs of the abdominal cavity. A para-esophageal hernia can be complicated by strangulation with the development of an acute intestinal obstruction and disturbance of blood circulation in the strangulated organs

Causes of diaphragmatic hernia

A diaphragmatic hernia can develop during the period of fetal development and be congenital. The hiatal hernia has a clear hereditary predisposition and is often observed among family members in several generations. Acquired hernias can be the result of injuries, wounds, as well as surgical interventions on the organs of the abdominal cavity and diaphragm. They develop less often due to systemic diseases of connective tissue and infringement of the innervation of the diaphragm (most likely, the increasing of the previously existing small hernia occurs, which did not cause clinical signs before).

Symptoms of a diaphragmatic hernia

The clinical manifestations of a diaphragmatic hernia mainly depend on the magnitude of the defect. Large congenital hernias can lead to the fact that the stomach of the newborn and part of the small intestine are located in the chest, causing serious violations of breathing and hemodynamics. In adulthood, the main complaints of patients with diaphragmatic hernia are:

• Pain in the chest, arising periodically and, as a rule, associated with eating. In the case of ischemic heart disease, lung and mediastinal diseases a differential diagnosis is often required
• Respiratory disorders, as well as signs of chronic oxygen deficiency. A collapse and atelectasis of one of the lungs, caused by pressure from outside, is often observed
• Symptoms of heart failure. Violation of the ratio of the mediastinum organs leads to a displacement of the heart and major vessels, often leading to severe functional disorders of the cardiovascular system
• Sounds and sensation of peristalsis in the chest
• Symptoms of gastroesophageal reflux (pain in the epigastric region, heartburn, burning sensation behind the sternum, bad breath)
• Symptoms of intestinal obstruction in case of strangulation

Diagnosis of a diaphragmatic hernia

In the private clinic «Herzliya Medical Center» all modern diagnostic methods are used, which allow determining in due time the presence of a diaphragmatic hernia, among which:

• Ultrasound, including intrauterine ultrasound of the fetus
• Radiography (X-ray) with contrast medium. This method allows determining the penetration of the organs of the gastrointestinal tract into the cavity of the chest with high accuracy
• Tomography scanning (CT and MRI)
• Endoscopic gastroscopy

Based on the findings, clinic specialists will determine the type and severity of the disease, choosing the optimal and most effective treatment in Israel.

Correction of diaphragmatic hernia in the Herzliya Medical Center

Large congenital diaphragmatic hernia, accompanied by the movement of abdominal organs into the chest, requires urgent surgical intervention in the early days of the child’s life. During the correction of a diaphragmatic hernia, the reposition of the newborn’s displaced organs occurs, the returning of the stomach and intestines to the abdominal cavity and suturing the defect of the diaphragm is conducted. Emergency surgery due to life indications and age of patients is carried out by an open method.

Surgical treatment of late manifestations and acquired diaphragmatic hernias is carried out, mainly, by the laparoscopic method. Surgeons of the Herzliya Medical Center clinic prefer access to the diaphragm from the side of the abdominal cavity. During the operation, the integrity of the diaphragm is reconstructed and the displaced organs of the gastrointestinal tract are returned to the abdominal cavity. Often the procedure is performed in conjunction with fundoplication, which is an operation to eliminate gastroesophageal reflux. Laparoscopic procedures are easily tolerated by patients and do not require prolonged hospitalization.

For many years our private clinic has been the leading center of cavitary, endoscopic and minimally invasive surgery in Israel. Doctors of the Herzliya Medical Center Hospital have undergone training in the best surgical clinics in the USA, Europe, and Canada, specializing in modern laparoscopic procedures, gradually replacing the classical methods of open surgery. For the patients of the hospital an individual approach, a highly professional post-operative care, an excellent service, as well as a warm and humane attitude of the multidisciplinary team are guaranteed.