Esophageal hernia (hiatus hernia) is a disease caused by the entry of intra-abdominal organs (mainly stomach) into the thoracic cavity through the diaphragmatic esophageal hiatus. Pathogenesis: 1. congenital factors of esophageal hypoplasia; 2. atrophy of the structure of the esophageal hiatus such as muscle or weakened muscle tone; 3. acquired factors of long-term abdominal pressure increase, such as pregnancy, ascites, chronic cough, habitual constipation, etc. can cause the body of the stomach to herniate above the diaphragm and form an esophageal hiatus hernia; 4. post-surgical hiatus hernia, such as surgery on the upper part of the stomach or cardia, which destroys the normal structure can also cause hernia; 5. 5. traumatic hiatal hernia. Clinical typology: 1. Sliding esophageal hiatal hernia (reversible hiatal hernia), the most common. The muscle tone of the esophageal hiatus is weakened, the mouth of the esophageal hiatus is enlarged, the diaphragmatic esophageal ligament and the diaphragmatic gastric ligament that hold the cardia in place are relaxed, which increases the range of motion of the cardia and the gastric fundus, and under increased abdominal pressure, the cardia and the gastric fundus protrude into the intrathoracic mediastinum through the enlarged esophageal hiatus. 2. Para-esophageal hernia is less common, accounting for only 5%-20% of hiatal hernias, and manifests as a part of the stomach (gastric body or gastric sinus) entering the thoracic cavity through the widened and relaxed hiatal foramen in the left front of the esophagus. Sometimes there is also a herniation of the large gastrocolic omentum. However, the esophagogastric junction lies below the diaphragm and remains at an acute angle, so gastroesophageal reflux rarely occurs. If the herniated part is large, including the fundus and upper part of the gastric body (giant hiatal hernia), the gastric axis is twisted and turned over, and serious consequences such as ulcer bleeding, impaction, strangulation, and perforation can occur. 3.Mixed esophageal hiatal hernia This type is the least common, accounting for about 5%, and refers to the coexistence of sliding esophageal hiatal hernia and paraesophageal hernia, often as a result of oversized diaphragmatic esophageal hiatus. It is characterized by the upward migration of the fundus of the stomach and even the main body of the stomach, the lesser curvature, in addition to the sliding of the gastroesophageal junction into the posterior mediastinum from the abdominal cavity, along with the enlargement of the foramen ovale. Due to the enlargement of the hernia sac and the increasing contents of the hernia, the lung and heart can be compressed to produce different degrees of lung atrophy and heart displacement. 4. Short esophageal hiatal hernia is mainly due to shortening of the esophagus. It can be caused by esophageal fibrosis due to long-term reflux esophagitis, or after surgery, or due to congenital causes of esophageal shortening. Clinical symptoms: 1. Gastroesophageal reflux symptoms: Burning sensation behind the sternum or under the glabella, regurgitation of gastric contents, epigastric fullness, belching, pain, etc. The nature of pain is mostly burning or pins-and-needles pain, which can radiate to the back, shoulders, neck, etc. The symptoms may be triggered and aggravated by lying down, eating sweet and acidic foods. This symptom is especially common in sliding type hiatal hernia. (2) Complication symptoms (1) Bleeding: hiatal hernia can sometimes bleed, mainly due to esophagitis and herniorrhaphy, mostly due to chronic small amount of bleeding, which can lead to anemia (2) Reflux esophageal stricture: in a few patients with reflux symptoms, organic stricture occurs, resulting in symptoms such as dysphagia, painful swallowing, and vomiting after eating (3) Ingrown hernia sac: usually seen in paraesophageal hernia. If a patient with hiatal hernia has sudden severe epigastric pain with vomiting, complete inability to swallow or simultaneous hemorrhage, it suggests acute impaction. 3. symptoms of hernia sac compression When the hernia sac is large and compresses the heart, lungs and mediastinum, it can produce symptoms such as shortness of breath, palpitation, cough and cyanosis. When the esophagus is compressed, it can be felt that there is esophageal stagnation behind the sternum or swallowing difficulty.