The most common diaphragmatic hernias (axial diaphragmatic hernias) are harmless and only require surgery if they cause discomfort. These are the axial sliding hernias. Here the stomach entrance slides through the enlarged passage through the diaphragm in an axial direction upwards into the chest. This is often dependent on the position of the patient.
If at the same time the function of the stomach entrance is disturbed (cardia insufficiency) and this leads to heartburn (reflux of the gastric juice into the esophagus) and if this "reflux disease" cannot be treated sufficiently with medication, the axial diaphragmatic hernia is also removed during the operation for reflux disease.
Certain forms of diaphragmatic hernia always require surgery. This is when parts of the stomach or even almost the entire stomach ("upside-down stomach" or "thoracic stomach") slides up into the thoracic cavity next to the entrance of the esophagus into the abdominal cavity (paraesophageal hernias up to the "thoracic stomach"). Such a situation carries the risk of incarceration of parts of the stomach (life-threatening emergency) or the development of ulcers and chronic bleeding. These hernias often cause complaints such as chest pain, belching and heart pain, which are initially wrongly attributed to other causes.
We perform surgery on paraesophageal hernia, if there are no other reasons against it, minimally invasive via laparoscopy. In this procedure, as in the open surgical procedure (via abdominal incision), the stomach is completely relocated back into the abdominal cavity and attached to the diaphragm with sutures (gastrophrenicopexy). At the same time, the passage (hernia gap) at the diaphragm is narrowed with a few sutures (hiatoplasty).