ESOPHAGEAL HERNIA- TYPES AND MANAGEMENT

: Introduction: The incidence of Esophageal adenocarcinoma has been rapidly elevating around the world, specifically in America and Europe. Now, the US stated that there are up to 17,000 patients who die every year because of esophageal cancer. This malignant disease involves gastroesophageal reflux, causing abnormal growth within the inner mucosal lining with a rapid development of malignant cells. One of the most important predisposing factors for developing esophageal cancer is considered to be hiatal hernia, which is known as dilatation of the hiatus of the esophagus, associated with debilitated muscles of the diaphragm, elevated intraabdominal pressure, along with other features that will be discussing through this review. Until the 70s, it was thought that having hiatal hernia was the only predisposing factor for developing gastroesophageal reflux. However, the presence of abnormalities in the pressure of the lower esophageal sphincter emerged later to be the most important feature predisposing for GERD. Aim of work: In this review, we will discuss Esophageal hernia- types and management. ethodology: We did a systematic search for Esophageal hernia-types and management using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). All relevant studies were retrieved and discussed. We only included full articles. Conclusions: Surgical operation modalities are likely to be to be the only definitive treatment for any underlying esophageal hiatal hernia in all age groups. A post-operative positioning of herniated organs will also decrease the physiological abnormalities associated with clinical manifestations of the hiatal hernia. The best surgical procedure is considered to be laparoscopic Nissen fundoplication. Interestingly, recent reports have been suggesting that surgical operations can be done in patients who have severe GERD, correlated with their hiatal hernia, especially in cases with expulsions of the esophagus or the pharynx. Higher BMI and/or age have been found to significantly increase the risk of developing a hiatal hernia, with some reports of redo surgeries and fundoplication. however, laparoscopic interventions can also trigger the formation of gas along with developing difficulties in swallowing, which might also cause mortality in about five percent of the operated population.