a Department of Thoracic Surgery , China-Japan Union Hospital of Jilin University , Changchun , China.
Expert Rev Gastroenterol Hepatol. 2018 Apr;12(4):319-329. doi: 10.1080/17474124.2018.1441711. Epub 2018 Feb 22.
Esophageal hiatal hernia involves abnormal abdominal entry into thoracic cavity. It is classified based on orientation between esophageal junction and diaphragm. Sliding hiatal hernia (Type-I) comprises the most frequent category, emanating from right crus of diaphragm. Type-II esophageal hernia engages both left and right muscular crura. Type-III and IV additionally include the left crus. Age and increased body mass index are key risk factors, and congenital skeletal aberrations trigger pathogenesis through intestinal malrotations. Familiar manifestations include gastric reflux, nausea, bloating, chest and epigastric discomfort, pharyngeal and esophageal expulsion and dysphagia. Weight loss and colorectal bleeding are severe symptoms. Areas covered: This review summarizes updated evidence of pathophysiology, risk factors, diagnosis and management of hiatal hernias. Laparoscopy and oesophagectomy procedures have been discussed as surgical procedures. Expert commentary: Endoscopy identifies untreatable gastric reflux; radiology is better for pre-operative assessments; manometry measures esophageal peristalsis, and CT scanning detects gastric volvulus and associated organ ruptures. Gastric reflux disease is mitigated using antacids and proton pump and histamine-2-receptor blockers. Severe abdominal penetration into chest cavity demands surgical approaches. Hence, esophagectomy has chances of post-operative morbidity, while minimally invasive laparoscopy entails fewer postoperative difficulties and better visualization of hernia and related vascular damages.
食管裂孔疝涉及腹部异常进入胸腔。它根据食管连接处和膈肌之间的方向进行分类。滑动性裂孔疝（I 型）是最常见的类型，源自膈肌的右脚。II 型食管裂孔疝累及左右脚的肌肉。III 型和 IV 型此外还包括左脚。年龄和体重指数增加是主要危险因素，先天性骨骼畸形通过肠旋转不良引发发病机制。常见的表现包括胃食管反流、恶心、腹胀、胸部和上腹部不适、咽部和食管排出以及吞咽困难。体重减轻和结直肠出血是严重的症状。涵盖领域：本文综述了食管裂孔疝的病理生理学、危险因素、诊断和治疗的最新证据。腹腔镜和食管切除术已被讨论为手术程序。专家评论：内镜检查可识别无法治疗的胃食管反流；放射学更适合术前评估；测压法测量食管蠕动，CT 扫描检测胃扭转和相关器官破裂。使用抗酸剂和质子泵抑制剂以及组胺 2 受体阻滞剂来减轻胃食管反流病。严重的腹部穿透到胸腔需要手术方法。因此，食管切除术有术后发病率的机会，而微创腹腔镜手术术后并发症较少，对疝和相关血管损伤的可视化效果更好。
