More than 400 laparoscopic surgeries on patients with hiatal hernia have been performed at the First Clinic of Surgery at University Hospital “St. Marina" – Varna over the past year. The highly qualified teams of specialists, headed by Prof. Dr. Krasimir Ivanov, can boast plenty of years of experience in the field of General and Abdominal Surgery and extensive expertise in bloodless operations. The Clinic is among the most advanced in Bulgaria, equipped with cutting-edge medical appliances for diagnosis and innovative treatment of the disease.
Assoc. Prof. Aleksander Zlatarov from the First Clinic of Surgery at UMHAT “St. Marina" – Varna explained that a hiatal hernia is a condition in which part of the patient's stomach passes from the abdominal cavity to the chest. The doctor specified that the cause of the disease is a pathological enlargement of an opening in the diaphragm, called the hiatus, through which the esophagus passes. The opening increases with the weakening of the muscle tissue of the diaphragm, which separates the abdominal cavity from the chest area as a partition. The diaphragm muscle becomes loose due to obesity, age-related changes, trauma, previous operations, pregnancy and physical exercises.
Assoc. Prof. Aleksander Zlatarov explained that the symptoms include a variety of complaints and depend on the type and size of the hernia. The most common complaints are associated with heartburn, burning pain behind the sternum, heaviness in the abdomen and eating problems. Hiatal hernia can also cause anaemia, easy fatigue and heart palpitations. According to doctors, the symptoms of this condition often coincide with those of other diseases, so postponing a specialist examination and self-medication can lead to serious consequences for patients' health.
Depending on their anatomy, hiatal hernias are classified into two main types. The most common hernias are the so-called sliding hernias, in which the lower part of the esophagus and part of the stomach “slide" up toward the chest. Another type is paraesophageal hernias, which are often larger in size and lead to complications. In these cases, not only part of the abdomen but also other internal organs pass into the chest cavity. The other types of hiatal hernias are combinations of the previous two types.
The physicians at the First Clinic of Surgery at the University Hospital are explicit that the differentiation of the various conditions by highly qualified specialists is essential in order to determine the correct treatment. Complaints of patients with hiatal hernias and gastroesophageal reflux disease often overlap, but in the first case, anti-acid drugs have only a temporary effect. Specialists advise seeking medical help for complaints that do not subside within a month. Immediate examination by a surgeon is required in cases of vomiting and severe pain in the upper abdomen.
“To diagnose and determine the type of hiatal hernia, imaging and endoscopic methods are used, such as contrast radiography and gastroscopy, which allows the esophagus, stomach and duodenum to be examined for anatomical changes and changes in the mucosa," explained Assoc. Prof. Zlatarov. He added that in some cases, especially with large hernias, a computed tomography scan is required. Following the diagnostic tests, the surgical team develops a treatment plan.
The specialists at the Clinic specified that surgical intervention is rarely necessary for patients with small hiatal hernias. In the rest of the cases, laparoscopic surgery is the “gold standard" because it is a minimally invasive approach involving very small incisions, resulting in a quick and painless recovery for the patient. The aim of the procedure is to restore the normal size of the opening in the diaphragm, return the stomach to the abdominal cavity, and make a valve mechanism between the esophagus and the stomach. A newer and more precise treatment method is robot-assisted surgery, in which the specialist controls fine instruments with capabilities that exceed those of the human hand.
During the medical consultation at the First Clinic of Surgery at University Hospital “St. Marina" in Varna, the specialists determine which method is the most appropriate for treating a patient with hiatal hernia, given the condition, age, accompanying diseases, and the severity of his/her symptoms.
Velina Markovska
