1. ABDOMINAL HERNIAS
The hernia is a protrusion or exit from its usual spot of an organ or part of our body. In the abdomen, are the most common hernias inguinal hernias, epigástricas and umbilicals.
Appear in the groin area also called inguinal region. Are much more frequent in men. Can happen after an effort. Can appear at any time of our life. The symptoms are a “chat” or tumor that increases with the effort. The trend is to increase over time.
Anatomical point of view, the inguinal hernias can be direct or indirect.
Hernias Surgery treatment is always surgical. There are different operative techniques. Currently, there are in many cases networks to strengthen the wall and occlude the defect.
If not surgically hernia, normal is the default enlargement and over time the incarceration or strangulation of the hernia. This makes the situation urgent because it can get to cause an intestinal perforation.
At Clínica Luso Espanhola we recommend to operate the hernias as quickly as possible to prevent serious complications in the future and make the procedure much simpler.
Are hernias from the midline of the abdomen, often above the navel. The treatment is always surgical. Can easily mask the symptoms and be difficult to diagnose.
Umbilical hernia is caused by a defect in the closure of the umbilical scar that can be congenital or acquired during life.
In children, in General, the umbilical hernia closes up to 2 years, but case persists up to five years, you will need surgical treatment.
1. Incarceration. A part of the abdominal contents remained in the bag herniário, outside the abdominal cavity. Thus, the viscera cannot return to its proper place.
2. Choke. There is incarceration and suffering of the intestine or any other structure within the herniário bag. The compression of blood vessels is what causes this suffering.
The incarceration is an emergency, and surgery for the treatment of hernia must be conducted as soon as possible.
2. HIATUS HERNIA/GASTROESOPHAGEAL REFLUX DISEASE GASTROESOPHAGEAL
Chronic illness caused by gastrointestinal contents reflux into the esophagus. The reflux is often associated with a gastroesofágica hernia (the stomach herniated through the hole in the diaphragm into the chest). Are more frequent in the elderly, male, pregnancy, obesity, Scleroderma, Gastrinoma, Medication, gastric surgery. The most common symptoms are heartburn, heartburn and regurgitation. Odynophagia can occur more rarely or dysphagia. Other rare symptoms are the sinuses and bronchospasm.
The complications are cancer (esophagus Barrett/Adenocarcinoma of the Esophagus), Esophageal ulcer, bleeding and the stricture.
The diagnosis is made by performing an upper gastrointestinal Endoscopy.
The hiatal hernia can be sliding, paraesofágica or mixed.
Appears in more than half of the refluidores. The classification of Los Angeles for Esophagitis divides this in 4 degrees:
1. A grade Esophagitis: Erosion restricted to mucosa, under 5 cm.
2. B grade Esophagitis: restricted the mucosa Erosion, greater than 5 cm but not continuous between two folds.
3. C grade Esophagitis: continuous Erosions between pleated, but committing less than 75% of the circumference of the oesophagus.
4. D grade Esophagitis: Erosion compromising more than 75% of esophageal circumference.
The treatment is done with Anti acids and prokinetic agents such as Cisapride and metoclopramide and Proton pump inhibitors (omeprazole, Lansoprazole and Pantoprazole). Can also be used the oldest histamine receptor blockers-2: Ranitidine and Cimetidine.
The definitive treatment is surgical, always by conducting of Nissen Surgery laparoscopically.
Due to low morbidity and mortality of the procedure, the patient must actively participate in the choice of treatment, especially if you do not want to continue with medical treatment.