"Hello! I can’t find material anywhere about erosion of the esophagus (as a result of a hernia hiatus). This is exactly the diagnosis I was given more than a year ago. I had prosthetic surgery in May last year. hip joint, and the erosion worsened. From medications special effect I don't receive it. From mouth - bad smell, which I can’t drown out with anything. In addition, I experience pain when swallowing. Maybe there is folk remedies from this misfortune? I really hope for your help in . Sincerely, Irina Evgenievna, Tambov region, Petrovsky district.”
We asked the doctor, Ph.D., to respond. Selivanov A.D.:
Let's start, perhaps, with the most important thing: what are the reasons for the appearance of such hernias? The main points in the development of hernias can be: increased intrauterine pressure; shortening of the esophagus (scarring-inflammatory process, tumor, etc.); decreased muscle tone; atrophy of the left lobe of the liver; complete disappearance of adipose tissue under the diaphragm; stretching of the esophageal opening in the diaphragm; rachiocampsis thoracic(kyphosis) in the elderly and old age and others. These factors most often lead to the development of axial (axial, sliding) hernias.
The disease is often vague and asymptomatic. However, burning, sharp and dull pain in the chest, in the abdominal cavity with various irradiations, often provoking angina pain. Unpleasant painful sensations usually associated with eating, a sudden change in body position, accompanied by a feeling of fullness, decrease significantly in an upright position. Frequent symptoms also include belching, hiccups, regurgitation, vomiting, dysphagia (swallowing disorder), increased salivation, oral bad smell. In particular, for our reader, a complication of the disease was the development of esophageal erosion.
The diagnosis is usually made after a thorough x-ray examination in the clinic, which allows you to quickly identify the hernia and confirm gastrointestinal reflux (reflux). Moreover, the inspection is carried out not only in a vertical position, but also in horizontal position patient. Esophagogastroscopy allows you to assess the level of esophagitis (inflammation of the esophagus) and diagnose an axial hernia. Besides, specific diagnostics axial hernias are carried out using the method of graphic recording inside the esophageal and gastric pressure - esophagotonocymography. Biochemical and general analysis blood, general urine analysis, stool blood test, etc.
We were asked about folk methods treatment, in this regard I can recommend treatment herbal infusions. This topic is large and I would like to dwell on it in more detail, but in the next posts. In the meantime, take advantage of one more piece of advice - buy a comfortable and healing mattress, which you can choose from the Matras-Inter online store - the manifestation of the disease being considered today depends on the position of the body in sleep. And prepare the following plants for collection, we will prepare them - knotweed root, crushed calamus rhizome, stinging nettle flowers, crushed dandelion roots, oregano, corn silk and crushed blood-red hawthorn fruits.
Hiatal hernia is one of the most common anatomical and topographical defects of the gastrointestinal tract, accompanied by gastroesophageal reflux disease.
Currently, a fairly extensive analysis of the effectiveness of primary antireflux interventions has been carried out, and methods for selecting fundoplications have been determined.
Nikolay Sivets, head of the surgical department6th City Clinical Hospital of Minsk, Professor of the Department of Military Field Surgery of BSMU,doctor med. sciences
The essence of the operation is to correct the esophageal opening of the diaphragm and form a cuff from the fundus of the stomach around the abdominal esophagus and cardia. Interventions for hiatal hernia (HHH), as a rule, are performed using laparoscopic access, which reduces trauma, shortens the period of disability and speeds up rehabilitation.
Surgical treatment of hiatal hernia in long-term postoperative period accompanied by a fairly high percentage of relapses (from 11% to 30%). Good and excellent results are in the range of 84-86%. According to a number of authors, the relapse rate after laparoscopic correction of giant hiatal hernias (with a surface area of the esophageal opening of the diaphragm more than 20 cm 2) is 25-40%.
Feature operations: sutures are applied to the diaphragmatic legs that have already become unfibered and have undergone degeneration. As a result, the diaphragm tissue erupts, creating conditions for the migration of the applied fundoplication cuff into the posterior mediastinum with the development of recurrent pathology. An attempt to apply sutures to intact tissue, while involving a large number of diaphragmatic crura, can lead to persistent postoperative dysphagia due to excessive narrowing of the esophageal opening of the diaphragm.
Specific mechanisms and types of relapses are well known: slipping of the fundoplication cuff, or telescope syndrome, displacement of the cuff into the chest cavity above the diaphragm, cutting through the sutures of the cuff or the sutures of the legs of the diaphragm, the formation of a paraesophageal hernia. Sliding of the fundoplication cuff above the diaphragm is most often observed when the crurorrhaphic suture fails. In second place is relapse due to rupture and disintegration of the diaphragmatic pedicle. The literature describes mechanical (manifested by dysphagia) and functional (manifested by heartburn) forms of relapse.
To improve the results of surgical treatment, plasty of the esophageal opening of the diaphragm is performed using a mesh implant. Many authors believe that the use of a grid is advisable only when large sizes esophageal opening of the diaphragm, atrophy of the diaphragmatic legs and in old age. The attitude towards polypropylene mesh is currently very restrained. The limited use of them in plasty of the esophageal opening of the diaphragm is explained by frequent complications (long-term dysphagia in the postoperative period, cicatricial strictures, erosion of the esophagus by the implant and migration of the implant). At the same time, the indications for placing the mesh have not been worked out.
When repeated operations for recurrent hiatal hernias are performed, Nissen fundoplication is used in approximately 70% of cases, and Toupet fundoplication is used in 17-20% of cases. Indications for re-intervention: recurrent hiatal hernia, especially if there is recurrent development of reflux, reflux esophagitis or other manifestations of gastroesophageal reflux disease (heartburn, dysphagia, vomiting, chest pain). It has been proven that with repeated operations their effectiveness decreases, and the greater the number of previously performed interventions, the lower the effectiveness of each subsequent one. This fact requires a careful approach to determining indications for refundoplication. To accurately determine whether reoperation is feasible, it is necessary to conduct a comprehensive clinical and X-ray endoscopic examination.
Patient V., 69 years old, resident of Polotsk, was hospitalized in the surgical department of the 6th City Clinical Hospital of Minsk on May 29, 2017 with a recurrent hiatal hernia.
From the anamnesis: in 2009 she was operated on in one of the clinics in Vitebsk. Completed endoscopic surgery in the scope of posterior crurorrhaphy with installation of a polypropylene mesh behind the esophagus, fundoplication according to Nissen. A year later, a recurrence of the hiatal hernia occurred, and the patient was operated on again in the same clinic. A left-sided thoracotomy and plasty of the esophageal opening of the diaphragm by suturing it were performed. About four years after the second operation I felt satisfactory. The deterioration of the condition has been noted over the past two years. I began to experience chest pain, bitterness in my mouth, and belching.
In April 2017, the patient was consulted at surgical department 6th City Clinical Hospital of Minsk. Additional examination was recommended for differential diagnosis. Comprehensive clinical, endoscopic and x-ray examination, as a result of which it is installed clinical diagnosis: recurrent hernia esophageal opening of the diaphragm. On May 29, the patient was hospitalized and operated on the next day. Reconstructive surgery was performed on the esophagus and stomach: laparotomy, hernia repair, anterior crurorrhaphy, Nissen refundoplication. The duration of the operation is 3 hours 40 minutes.
FROM THE OPERATION RECORD:
upper-median laparotomy with bypass of the umbilicus on the left. An audit of the abdominal organs revealed that there was a moderate adhesive process in the abdominal cavity after the previous operation. The large oil seal is soldered to the front abdominal wall, to the liver, to the gall bladder bed. In the subhepatic space on the left, in the area of the esophageal opening of the diaphragm, there is a massive adhesive process.
Upon further inspection, it was determined that there was a recurrence of the hiatal hernia. The adhesions are separated, and the hernial orifice is isolated (diameter about 5 cm). Behind the esophagus, a mesh implant is palpated, which is fixed to the legs of the diaphragm. The area of the esophagogastric junction on the lower right is tightly fixed to the implant. An attempt to remove the mesh implant was accompanied by tissue trauma and moderate diffuse bleeding.
Two metal brackets removed. The mesh implant was left in its original place. The parietal peritoneum was dissected in the area of the hernial orifice along the left wall of the esophageal opening of the diaphragm. The stomach in the cardiac region was mobilized along the lesser curvature, two short gastrosplenic branches were crossed along the greater curvature. The abdominal part of the esophagus is isolated. The thoracic esophagus was mobilized down to 3 cm. The esophagus was displaced downward. There were no signs of the presence of a Nissen fundoplication cuff formed during the first operation. Self-destruction of the cuff occurred, apparently, due to resorption suture material or cutting seams.
Considering the above, an esophageal opening of the diaphragm up to 2.5 cm in diameter was formed by placing two sutures on the legs of the diaphragm in front of the esophagus. A Nissen fundoplication was performed with cuff formation using four sutures. The stomach, together with the esophagus, is fixed to the right leg of the diaphragm with one suture. On the left, the cuff is fixed to the diaphragm with one seam. Hemostasis control. Drainage tube into the subhepatic space to the plastic area, the second - above the spleen. Instruments were removed from the abdominal cavity. Layered suture of the wound with a mechanical skin suture. Bandage.
In the first days after surgery, severe dysphagia was observed. The patient could only take liquid food in small portions. On the 9th day after surgery, a control FEGDS was performed.
ENDOSCOPIC IMAGE :
The esophagus is freely passable, the mucous membrane is pink, with curdled mycotic deposits on it. The cardia closes. The cuff is formed in the area of the cardia and is passable without effort for endoscopes sequentially 5.2 mm and 8.0 mm in diameter. Empty contents with copious admixture of bile. The gastric mucosa is focally hyperemic, edematous, the relief is preserved. The pylorus, bulb and cavity of the duodenum are without features.
CONCLUSION :
condition after hernioplasty with fundoplication according to Nissen. Erythematous gastropathy of the 1st degree. Mycosis of the esophagus.
Over the next four days the conservative therapy. Two weeks after the operation, on June 13, the patient was discharged in satisfactory condition for outpatient treatment.
conclusions
1. B modern conditions use of minimally invasive endoscopic method surgical treatment The hiatus hernia is promising direction in esophageal surgery.
2. To prevent recurrence of the hernia, it is necessary to observe the basic principle of surgical treatment: not only to eliminate the hernia, narrow the hernial orifice, but also to restore normal interaction between the stomach and the esophagus.
3. In case of failure of crurorrhaphy sutures, cutting of sutures or dissection of the diaphragmatic leg, the task of reoperation is to restore the usefulness of the plastic and the size of the esophageal opening of the diaphragm.
4. The use of synthetic mesh endoprostheses for surgical correction The hiatal hernia is considered a convenient immediate solution to the problem, but in case of recurrence of the hernia, this may prevent high-quality reconstructive surgery. Mesh implants can only be considered as an option when surgical treatment giant hiatal hernia.
Correction diaphragmatic hernia in Israel, it is successfully carried out in the surgical department of the private clinic “Herzliya Medical Center”. Application innovative techniques laparoscopic surgery allowed hospital specialists to minimize the risk postoperative complications, as well as the duration of inpatient treatment.
What is a diaphragmatic hernia?
The diaphragm is a dome-shaped muscular structure that separates the cavity chest from the abdominal cavity. Besides barrier function, the diaphragm muscles play important role during breathing. The diaphragm has a series of holes that allow the digestive and circulatory systems penetrate from the chest cavity into the abdominal cavity. Muscle around these openings there is a relatively weak link in the organ, which often causes pathological expansion and insufficiency of barrier function, called a diaphragmatic hernia or hiatal hernia.
Types of diaphragmatic hernias
One of the common manifestations of a diaphragmatic hernia is a hernia of the esophageal opening of the diaphragm - the place where the esophagus enters the abdominal cavity. Small hernias interfere with the normal functioning of the esophagogastric sphincter, being the main cause of reflux (the return of stomach contents to the esophagus). Large hiatal hernias can cause abnormal penetration of abdominal organs into the chest with serious functional impairment and severe symptoms.
In clinical practice, the most common types of diaphragmatic hernias are:
- Sliding hiatal hernia. This type of hiatal hernia is observed in 70-80% of cases. The weakness of the esophageal opening ring leads to free displacement of the posterior-superior part of the stomach, not covered by the peritoneum, into the chest cavity. In the vast majority of cases, the stomach returns unhindered to the abdominal cavity, which explains the name of this pathology. Sliding diaphragmatic hernias are not strangulated, and, as a rule, are accompanied by gastroesophageal reflux, as well as secondary changes in the mucous membrane of the esophagus (reflux esophagitis);
- Paraesophageal hiatal hernia characterized by a defect to the left of the esophagus, usually not exceeding 10 centimeters. The resulting hernial sac is covered on the side of the abdominal cavity by the peritoneum, which over time undergoes pronounced fibrous changes. Unlike a sliding hernia, top part The stomach remains fixed, while the hernial sac may contain part of the body of the stomach or other abdominal organs. Paraesophageal hernia can be complicated by strangulation with the development of acute intestinal obstruction and impaired blood circulation in the strangulated organs.
Causes of development of diaphragmatic hernia
Diaphragmatic hernias can develop during intrauterine development and be innate in nature. Esophageal hernia has a clear hereditary predisposition and is often observed in family members over several generations. Acquired hernias can be the result of trauma, injury, as well as surgical interventions on the abdominal organs and diaphragm. Less likely to develop due to systemic diseases connective tissue and disturbances in the innervation of the diaphragm (most likely, there is an increase in a previously existing small hernia that did not previously cause clinical manifestations).
Symptoms of diaphragmatic hernia
The clinical manifestations of a diaphragmatic hernia depend mainly on the size of the defect. Large congenital hernias can cause the newborn's stomach and part small intestine located in the chest, causing serious respiratory and hemodynamic disturbances. IN mature age main complaints of patients with diaphragmatic hernia th are:
- Chest pain that occurs periodically and is usually associated with eating. Often required differential diagnosis With coronary disease heart disease, diseases of the lungs and mediastinum;
- Breathing disorders, as well as signs of chronic oxygen deficiency. Collapse and atelectasis of one of the lungs, caused by external pressure, is often observed;
- Symptoms of heart failure. Violation of the relationship between the mediastinal organs leads to displacement of the heart and great vessels, often leading to severe functional disorders from the cardiovascular system;
- Sounds and sensation of peristalsis in the chest;
- Symptoms of gastroesophageal reflux (epigastric pain, heartburn, burning sensation in the chest, bad breath;
- Symptoms of intestinal obstruction in case of strangulation.
Diagnosis of diaphragmatic hernia
The private clinic “Herzliya Medical Center” uses all modern methods diagnostics that allow timely determination of the presence of a diaphragmatic hernia, including:
- Ultrasound examination, including intrauterine ultrasound of the fetus;
- X-ray using contrast agent. This method allows you to accurately determine the penetration of organs gastrointestinal tract into the chest cavity;
- Tomographic scanning (CT and MRI);
Based on the data obtained, the clinic’s specialists will determine the type and severity of the disease, choosing the optimal and most effective treatment in Israel.
Correction of diaphragmatic hernia at the Herzliya Medical Center clinic
Large congenital diaphragmatic hernias, accompanied by movement of the abdominal organs into the chest, require emergency surgical intervention in the first days of a child's life. During the correction of a diaphragmatic hernia in a newborn, the displaced organs are repositioned, the stomach and intestines are returned to the abdominal cavity, and the diaphragm defect is sutured. Emergency surgery in view of vital signs and age of patients is performed using an open method.
Surgical treatment of late manifestations and acquired diaphragmatic hernias is carried out mainly using the laparoscopic method. Surgeons at the Herzliya Medical Center clinic prefer access to the diaphragm from 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, 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 is a leading center for abdominal, endoscopic and minimally invasive surgery in Israel. Doctors of the Herzliya Medical Center hospital underwent training in the best surgical clinics USA, Europe and Canada, specializing in modern laparoscopic procedures, which gradually replaced classical methods open surgery. Hospital patients are guaranteed individual approach, highly professional post-operative care, excellent service, as well as a warm and humane attitude from a multidisciplinary team.
Congenital diaphragmatic hernia
Congenital diaphragmatic hernia is a malformation of the diaphragm, leading to disruption of the separation of the abdominal cavity and chest, as well as to displacement of the stomach, spleen, intestines and liver into the chest cavity.
Causes
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Congenital diaphragmatic hernia can be an isolated defect, or it can also be combined with malformations of other organs and systems. Most cases of congenital diaphragmatic hernia are sporadic.
With a congenital diaphragmatic hernia at 8-10 weeks of pregnancy, a defect in the diaphragm occurs as a result of disruption of the process of closing the pleuroperitoneal canal, and the abdominal organs can ventrate through the defect into pleural cavity during the entire period after the return of the intestines to the abdominal cavity (9-10 weeks of gestation). The presence of abdominal organs in the chest limits the growth and development of the lungs, which leads to pulmonary hypoplasia with decreased total number branches of bronchi and arteries. On the side of the hernia there is significant lung damage, however, the contralateral lung, as a rule, also has an abnormal structure and less weight compared to the norm.
Incidence rate 1 in 4000 live births, sex ratio 1:1
Diaphragmatic hernia can be combined with heart defects, which account for about 20%. Combinations with defects of the central nervous system and urinary system account for 10.7% each. About 10-12% of congenital diaphragmatic hernias diagnosed prenatally are integral part various hereditary syndromes (Cantrell pentad, Frinze, Lange, Marfan, Ehlers-Danlos syndromes, etc.) or the manifestation of chromosomal abnormalities and gene disorders. The average incidence of chromosomal abnormalities is 16%. Once again, it should be emphasized that chromosomal abnormalities are often detected only in cases where congenital diaphragmatic hernia is combined with other developmental defects. Consequently, prenatal karyotyping is indicated in all cases of concomitant pathology to clarify the genesis of the defect.
Regarding the affected side, all congenital diaphragmatic hernias are divided into:
- Left-handed about 80%
- Right-sided about 20%.
- Bilateral less than 1%.
Clinical manifestations
Most newborns with congenital diaphragmatic hernia develop a picture of respiratory failure directly in the delivery room immediately after birth. Acute disease progresses very quickly respiratory failure. On examination, attention is drawn to the asymmetry of the chest with bulging of the affected side (usually on the left) and the absence of chest excursion on this side. Very characteristic symptom- sunken navicular abdomen.
Diagnostics
The main method of prenatal detection of congenital diaphragmatic hernia is echography. During ultrasound examination, suspicion of this defect arises from an abnormal image of the chest organs. One of the main echographic signs is the displacement of the heart, as well as the appearance of the stomach and loops of the small intestine in the chest. Prenatal ultrasonography can detect the presence of abdominal contents in the chest as early as 12 weeks of pregnancy. However, diagnosis is usually made at 16 weeks of pregnancy.
Early diagnosis of CDH makes it possible to perform karyotyping to exclude a combined chromosomal abnormality. Also, according to ultrasound data in the first and second trimester of pregnancy, it is possible to determine the need for fetal interventions to stabilize a fetus with CDH.
After birth, the diagnosis of CDH is confirmed after comprehensive ultrasound and radiography of the chest and abdominal cavity.
Treatment methods
When a child is born with a diaphragmatic hernia, doctors must be prepared to perform an extended cardiopulmonary resuscitation. Tracheal intubation and mechanical ventilation are indicated from the first minute of life. Already in the delivery room, a child with CDH may require administration medicines, stabilizing the work of the heart. Only after reaching a stable condition is it possible to transport the child from the delivery room; this is performed in a transport incubator on a ventilator with monitoring of vital functions.
In the conditions of the intensive care unit, the department continues intensive therapy, aimed at stabilizing the condition and preparing for surgery: selection of methods and parameters of mechanical ventilation, cardiotonic support, sedative and analgesic, antibacterial therapy.
As the condition stabilizes, the question of the possibility of surgical treatment is decided.
In case of instability, our department has the opportunity to use the extracorporeal method of supporting the functioning of the heart and lungs - ECMO.
Surgical treatment of children with CDH is carried out predominantly using minimally invasive methods. endoscopic method. Through minimal punctures of the chest (3 mm), the contents are carefully immersed from the chest cavity into the abdominal cavity. After which the diaphragm defect is assessed: in the case of a sufficiently developed native diaphragm, the defect is repaired using its own tissues, and in the case of a pronounced tissue deficiency, the defect is replaced by an implant (using synthetic material Gore-Tex and biological material Permacol).
In the postoperative period, intensive therapy continues, aimed at correcting deficits that persist until the hypoplastic lung recovers.
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Diaphragmatic hernia- movement of the abdominal organs into the chest cavity through congenital or acquired defects. There are congenital, acquired and traumatic hernias.
False hernias do not have peritoneal hernial sac. They are divided into congenital and acquired. Congenital hernias are formed as a result of non-closure in the diaphragm of the communications existing in the embryonic period between the thoracic and abdominal cavities. Traumatic acquired false hernias are much more common. They occur when the diaphragm is injured and internal organs, as well as with isolated ruptures of the diaphragm measuring 2-3 cm or more in both the tendon and muscle parts.
True hernias have a hernial sac covering the prolapsed organs. They occur when intra-abdominal pressure increases and the abdominal organs protrude through existing openings: through the sternocostal space (parasternal hernias - Larrey, Morgagni) or directly in the area of the underdeveloped sternal part of the diaphragm (retrosternal hernia), Bochdalek's diaphragmatic hernia - through the lumbocostal space. The contents of the hernial sac in both acquired and congenital hernia can be the omentum, transverse colon, preperitoneal fatty tissue(parasternal lipoma).
True hernias of atypical localization are rare and differ from relaxation of the diaphragm by the presence of a hernial orifice, and therefore the possibility of strangulation.
Hiatal hernias are classified as a separate group, as they have a number of features
Clinical picture and diagnosis. The severity of symptoms of diaphragmatic hernia depends on the type and anatomical features displaced abdominal organs into the pleural cavity, their volume, degree of filling with contents, compression and bending in the area of the hernial orifice, degree of lung collapse and mediastinal displacement, size and shape of the hernial orifice.
Some false hernias (prolapse) may be asymptomatic. In other cases, symptoms can be divided into gastrointestinal, pulmonary-cardiac and general.
Patients complain of a feeling of heaviness and pain in the epigastric region, chest, hypochondrium, shortness of breath and palpitations that occur after a heavy meal; gurgling and rumbling in the chest on the side of the hernia and increased shortness of breath in a horizontal position are often noted. After eating, vomiting of ingested food occurs. When gastric volvulus is accompanied by a bend in the esophagus, paradoxical dysphagia develops (solid food passes better than liquid food).
When a diaphragmatic hernia is strangulated, sharp paroxysmal pain occurs in the corresponding half of the chest or in the epigastric region and symptoms of acute intestinal obstruction. Infringement of a hollow organ can lead to necrosis and perforation of its wall with the development of pyopneumothorax.
A diaphragmatic hernia can be suspected if there is a history of trauma, the complaints listed above, decreased mobility of the chest and smoothing of the intercostal spaces on the affected side. Also characteristic are retraction of the abdomen with large, long-standing stools, dullness or tympanitis over the corresponding half of the chest, changing intensity depending on the degree of filling of the stomach and intestines. During auscultation, peristaltic bowel sounds or splashing sounds in this area are heard with simultaneous pain or complete absence breathing sounds. There is a shift of mediastinal dullness to the unaffected side.
The final diagnosis is made when x-ray examination and more informative computed tomography. When the stomach prolapses into the pleural cavity, a large horizontal level of fluid is visible in the left half of the chest. When loops fall out small intestine against the background of the pulmonary field, individual areas of clearing and darkening are determined. Movement of the spleen or liver produces darkening in the corresponding part of the pulmonary field. In some patients, the dome of the pragma and abdominal organs located above it.
During a contrast study of the digestive tract, the nature of the prolapsed organs is determined (hollow or parenchymal), the location and size of the hernial orifice are specified based on the pattern of compression of the prolapsed organs at the level of the hole in the diaphragm (symptom of the hernial orifice). In some patients, to clarify the diagnosis, it is advisable to perform thoracoscopy or apply pneumoperitoneum. With a false hernia, air can pass into the pleural cavity (the picture of pneumothorax is determined by x-ray).
Treatment. Due to the possibility of strangulation of the hernia, surgery is indicated. If the hernia is located on the right side, the operation is performed through a transthoracic approach in the fourth intercostal space; for parasternal hernias better access is the upper median laparotomy; for left-sided hernias, transthoracic access is indicated in the seventh-eighth intercostal spaces.
After dividing the adhesions and freeing the edges of the defect in the diaphragm, the displaced organs are brought down into the abdominal cavity and the hernial orifice (defect in the diaphragm) is sutured with separate interrupted sutures to form a duplicate. If the diaphragm defect is large, it is covered with a synthetic mesh (lavsan, Teflon, etc.).
In case of parasternal hernias (Larrey's hernia, retrosternal hernia), the displaced organs are removed from the chest cavity, the hernial sac is everted and cut off at the neck. U-shaped sutures are applied and sequentially tied to the edges of the diaphragm defect and the posterior layer of the sheath of the abdominal muscles, the periosteum of the sternum and ribs.
In case of hernias of the lumbocostal space, the diaphragm defect is sutured with separate sutures to form a duplicate.
For strangulated diaphragmatic hernias, transthoracic access is performed. After dissection of the strangulating ring, the contents of the hernial sac are examined. If the viability of the prolapsed organ is preserved, it is replaced into the abdominal cavity; if the changes are irreversible, it is resected. The defect in the diaphragm is sutured.
