What is an esophageal hiatal hernia? The diaphragm is a flat muscle that separates the thoracic and abdominal cavities, and the esophageal hiatus is a fissure in the diaphragm. Under normal circumstances, the esophageal hiatus is just large enough to accommodate the passage of the esophagus. If the esophageal hiatus is enlarged for any reason, the pressure in the abdominal cavity is greater than that in the thoracic cavity, causing the stomach, omentum and even other abdominal organs to enter the thoracic cavity. This is called an esophageal hiatal hernia. What are the symptoms of esophageal hiatus hernia? A small hiatal hernia can be asymptomatic. As the disease progresses and the hernia gets larger, the following symptoms may occur: chest pain, heartburn, palpitations, difficulty swallowing, flatulence, belching, nausea, vomiting, malnutrition, aspiration (food returning to the airway), indigestion, gastric bleeding. Why do patients with esophageal hiatal hernia suffer from eating difficulties? The larger the hernia, the more tissue enters the chest cavity, which may cause chest pain, breathing difficulties and other symptoms. The larger the hernia is, the more tissue enters the thoracic cavity, which may cause chest pain, difficulty in breathing and other symptoms. What are the serious consequences of an esophageal hiatus hernia? Although most patients with esophageal hiatal hernia have mild symptoms, when the condition progresses with symptoms such as chest pain and difficulty breathing, it is often difficult to distinguish it from heart disease, and the diagnosis is sometimes delayed when tests are done on the heart. In the case of a twisted stomach in a hernia sac, ulcers sometimes bleed, and in the case of strangulated intussusception, it can cause life-threatening necrosis and perforation of the stomach wall. Fortunately, the number of patients with these manifestations is very small. How is a hiatal hernia treated? Small hiatal hernias with mild symptoms can be relieved by lifestyle changes, weight loss, and diet modification. When there are symptoms of reflux, acid control medications such as H2 blockers and proton pump inhibitors can be taken. Surgery is required when the hernia is large and the symptoms are severe. Gastroscopy, upper gastrointestinal tract imaging and esophageal function testing are required prior to surgery. What are the surgical treatments for esophageal hiatal hernia? Like other types of hernias, a hiatal hernia requires surgical repair. In addition to the traditional open repair, laparoscopic repair of a hiatal hernia has become widely accepted. The laparoscopic approach has the same advantages of other laparoscopic procedures in terms of less trauma and faster recovery, satisfactory results for patch repair of esophageal hiatal hernia, and the same possibility of laparoscopic fundoplication to reduce postoperative reflux if the patient has severe reflux symptoms. What are the advantages of laparoscopic treatment of esophageal hiatal hernia? The laparoscopic approach has the following advantages: good tissue separation and minimal postoperative pain with less intraoperative complications, less postoperative complications, and faster return to normal work. Patients with pre-operative underlying diseases, such as severe heart disease, COPD, etc., who cannot tolerate general anesthesia and pneumoperitoneum, or those with pre-existing hematologic diseases or coagulation disorders, are not eligible for laparoscopic surgery. Those who also have a history of major upper abdominal surgery, and sometimes severe intraoperative adhesions that make it impossible to identify the normal structure of the operated area, also need to be converted to open surgery. Is it safe to leave a patch in the body? Prior to the use of patches in laparoscopic surgery, the same material had been used in conventional surgery for more than 30 years with no reported adverse effects. Is laparoscopic surgery more expensive than open surgery? In terms of hospital costs, laparoscopic surgery does cost more than conventional surgery because it requires the use of some special instruments. However, in the case of patients who are still working, the costs are overall not higher than traditional surgery in terms of health economics assessment because the hospital stay is shorter and the return to normal work is quicker.