The diaphragm is a muscle that separates the thoracic cavity from the abdominal cavity, also having an important respiratory function since it allows pulmonary emptying. Due to the alteration of the diaphragmatic hiatus (hole that allows the passage of the stomach) to produce the protusion of the gastric upper to the thorax by triggering the appearance of the hiatus hernia. Under normal conditions, gastric acid does not reflies the stomach to the esophagus but in this case, when such protusion exists, the rise of acid occurs conditioning the appearance of gastroesophageal reflux.

Hiatus hernia

It is estimated that between 20% and 30% of the population could have hiatus hernia, and as a consequence the appearance of gastroesophageal reflux occurs. The symptomatology described by patients is acidity, difficulty swallowing and breathing, bad breath, dry cough as well as nausea and/or vomiting or bronchial asthma among others.

The causes that cause it are multiple, acquiring an important role the genetic predisposition (congenital defect). The risk of hiatus hernia increases with age, being more common in patients over 50 years.Obesity, constipation or repetitive vomiting condition an increase in intra -abdominal pressure being able to weaken the diaphragmatic membrane and with it the appearance of hiatus hernia. Tobacco, ascites or suffer of bronchitis are also triggered factors.

There are four different types of hiatus hernia:

• Type 1: Slide hernia.
• Type 2: Purely paraesophageal hernia.
• Type 3: Hernia of the Esophagogastric Union and Fundus.
• Type 4: In addition to the stomach, other viscera are hernian.

On some occasions they pass asymptomatically, being diagnosed after performing image tests such as chest radiography, gastrointestinal transit as well as high digestive endoscopy. When the patient in consultations describes the typical symptoms of the disease (ardor, pyosis, chest pain of non-cardiac cause, epigastric pain as well as abdominal swelling) in our unity of esophagus-gastric surgery hla vistahermosa we have protocolized the realization of various diagnostic tests Among which we find blood analytics, high digestive endoscopy with biopsies, gastrointestinal transit as well as the realization of an esophageal pHmetry and manometry.

If the patient is asymptomatic, he will not need treatment but periodic reviews with high digestive endoscopy with the possibility of biopsy to rule out long -term complications. In the event that it is symptomatic, in our Esophagus-Gastric Surgery Unit we begin treatment with postural and hygienic-dietary measures that in a considerable percentage of cases improve symptomatology.Among the initial conservative measures are the antacid medication administration (proton pump inhibitors or anti H2), avoid risk factors such as tobacco, alcohol or coffee intake, weight loss recommendation, rationalize daily food in small shots as well as postural measures with lifting of the bed of the bed to 45o to avoid the rise of gastric acid and therefore the night symptoms.

Among the indications of surgical treatment we find:

• No response to medical treatment. There is generally burning control with antacid medication but on certain occasions night regurgitations carry other types of complications such as repetition bronzes, pneumonia, etc ... that condition torpid evolution and need for surgical treatment.
• HIATO HERNIAS GIENDOS that condition the protusion, not only gastric, but also of other abdominal viscera, with the possible torsion, return or visceral incarceration.
• Esophageal problems such as barret esophagus, ulcers and/or bleeding.
• Surgical treatment decision by the patient.

The Gold Standard technique will be the realization of a Nissen melting with closure of the diaphragmatic pillars. In our HLAHAHERMOSA HLAHERMOSA ESPHAGO-GASTRIC SURGERY UNIT, with common protocols and extensive experience in contrasted laparoscopic surgery, we carry out the procedure minimally invasive, by carrying out small incisions, which condition less postoperative pain and a more recovery Early. The intervention consists in returning the stomach to the abdominal cavity with subsequent closure of the diaphragm and realization of a tie in the upper gastric portion as an anti -reflux measure.

Thanks to the realization of the surgical technique via laparoscopic, the patient has less postoperative pain, with early tolerance for oral feeding, allowing a better adaptation of body image by the patient.
In the immediate postoperative period, the patient will not require the medication he previously took for this pathology, having the surgical technique a long -term success above 90% of the interventions performed.

To conclude, we know that hiatus hernia is a relatively frequent pathology in society and in our HLAHLAS VIEHERMOSA Esophagus-Gastric Surgery Unit, with extensive experience in laparoscopic hernia repair, we offer a wide range of treatments, offering the patient the best Therapeutic option based on its symptomatology and comorbidity, being Nissen's melt with diaphragmatic pillars closure the surgical technique with better results.