{"id":14992,"date":"2025-04-22T15:37:23","date_gmt":"2025-04-22T15:37:23","guid":{"rendered":"https:\/\/venaziel.de\/general-medicine-your-family-practice-in-berlin-mitte-2\/hiatal-hernia-diaphragmatic-hernia-causes-symptoms-and-treatment-in-berlin\/"},"modified":"2026-04-09T12:45:35","modified_gmt":"2026-04-09T12:45:35","slug":"zwerchfellbruch","status":"publish","type":"page","link":"https:\/\/venaziel.de\/en\/hernienzentrum\/zwerchfellbruch\/","title":{"rendered":"Hiatal hernia (diaphragmatic hernia) &#8211; causes, symptoms and treatment in Berlin"},"content":{"rendered":"<p>At VenaZiel Hernia Center Berlin (Checkpoint Charlie),<span style=\"font-weight: 400;\"> we specialize in the diagnosis and treatment of hiatal hernias &#8211; using the most modern <\/span>, <i><span style=\"font-weight: 400;\">minimally invasive surgical methods<\/span><\/i><span style=\"font-weight: 400;\">  and many years of experience. This detailed guide explains   <\/span>all forms of hiatal hernia<span style=\"font-weight: 400;\">, their causes, symptoms and treatment options, so that you are well informed. <\/span> <\/p>\n<p><span style=\"font-weight: 400;\">We show when a <\/span><i><span style=\"font-weight: 400;\">diaphragmatic hernia operation<\/span><\/i><span style=\"font-weight: 400;\">  and what needs to be considered during aftercare. We also provide tips on nutrition and behavior as well as <a href=\"#toc_FAQ_Haufige_Fragen_von_Patienten_zur_Hiatushernie\">answers to frequently asked questions (FAQ)<\/a>. <\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><b>What is a hiatal hernia (diaphragmatic hernia)?<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">A hiatal hernia refers to the <\/span><b>passage of abdominal organs (usually parts of the stomach) upwards through the diaphragm<\/b><span style=\"font-weight: 400;\">  into the chest cavity. Normally, the esophagus and gastric junction pass through a narrow opening in the diaphragm, and the diaphragm supports the lower esophageal sphincter in holding the stomach contents down. In the case of a hiatal hernia, this support structure is weakened or stretched.    <\/span><\/p>\n<p><b>Consequence:<\/b><span style=\"font-weight: 400;\"> The upper part of the stomach or the stomach entrance (<\/span><i><span style=\"font-weight: 400;\">cardia<\/span><\/i><span style=\"font-weight: 400;\">) can slide upwards. As a result, part of the stomach is suddenly in the chest cavity instead of the abdominal cavity. This &#8221;  <\/span><i><span style=\"font-weight: 400;\">High slides<\/span><\/i><span style=\"font-weight: 400;\">&#8221; of the stomach through the diaphragmatic hiatus is the core of the hiatal hernia. A distinction is made between   <\/span><b>Hiatal hernia types<\/b><span style=\"font-weight: 400;\">  (see below), depending on which part of the stomach has shifted and how large the hernia is. Small hernias often cause no problems, while larger ones can lead to symptoms such as   <\/span><i><span style=\"font-weight: 400;\">heartburn<\/span><\/i><span style=\"font-weight: 400;\"> can lead to heartburn. <\/span> <\/p>\n<p><span style=\"font-weight: 400;\">Overall, the hiatal hernia is one of the <\/span>most common hernias in the abdominal area &#8211; especially in older people: it is estimated that over 50 % of people over 50 have a small hiatal hernia, often unnoticed.<\/p>\n<p><b>Anatomical representation: <\/b><span style=\"font-weight: 400;\">normal condition is shown at the top, a hiatal herniaat the bottom <\/span><span style=\"font-weight: 400;\">. In the picture below, the entrance to the stomach slides up through the diaphragm into the chest cavity (pink part of the stomach above the brown diaphragm). In this position, the sphincter muscle between the esophagus and stomach can no longer work properly, which often leads to   <\/span><span style=\"font-weight: 400;\"> leads to<\/span> reflux.<\/p>\n<p><picture class=\"wp-picture-15022\" style=\"display: contents;\"><source type=\"image\/avif\" srcset=\"https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Zwerchfellbruch-hiatushernie-anatomie-was-ist-das-definition-Venaziel-op-mvz-berlin-jpg.avif 1200w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Zwerchfellbruch-hiatushernie-anatomie-was-ist-das-definition-Venaziel-op-mvz-berlin-250x135-jpg.avif 250w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Zwerchfellbruch-hiatushernie-anatomie-was-ist-das-definition-Venaziel-op-mvz-berlin-1024x555-jpg.avif 1024w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Zwerchfellbruch-hiatushernie-anatomie-was-ist-das-definition-Venaziel-op-mvz-berlin-768x416-jpg.avif 768w\" sizes=\"(max-width: 1200px) 100vw, 1200px\"><img data-dominant-color=\"f2e8e7\" data-has-transparency=\"false\" style=\"--dominant-color: #f2e8e7;\" decoding=\"async\" class=\"lazyload alignnone size-full wp-image-15022 not-transparent\" src=\"https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Zwerchfellbruch-hiatushernie-anatomie-was-ist-das-definition-Venaziel-op-mvz-berlin.jpg\" data-orig-src=\"https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Zwerchfellbruch-hiatushernie-anatomie-was-ist-das-definition-Venaziel-op-mvz-berlin.jpg\" alt=\"diaphragmatic-hiatal-hernia-anatomy-what-is-this-definition-venaziel-op-mvz-berlin\" width=\"1200\" height=\"650\" title=\"\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%271200%27%20height%3D%27650%27%20viewBox%3D%270%200%201200%20650%27%3E%3Crect%20width%3D%271200%27%20height%3D%27650%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-srcset=\"https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Zwerchfellbruch-hiatushernie-anatomie-was-ist-das-definition-Venaziel-op-mvz-berlin-200x108.jpg 200w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Zwerchfellbruch-hiatushernie-anatomie-was-ist-das-definition-Venaziel-op-mvz-berlin-250x135.jpg 250w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Zwerchfellbruch-hiatushernie-anatomie-was-ist-das-definition-Venaziel-op-mvz-berlin-400x217.jpg 400w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Zwerchfellbruch-hiatushernie-anatomie-was-ist-das-definition-Venaziel-op-mvz-berlin-600x325.jpg 600w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Zwerchfellbruch-hiatushernie-anatomie-was-ist-das-definition-Venaziel-op-mvz-berlin-768x416.jpg 768w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Zwerchfellbruch-hiatushernie-anatomie-was-ist-das-definition-Venaziel-op-mvz-berlin-800x433.jpg 800w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Zwerchfellbruch-hiatushernie-anatomie-was-ist-das-definition-Venaziel-op-mvz-berlin-1024x555.jpg 1024w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Zwerchfellbruch-hiatushernie-anatomie-was-ist-das-definition-Venaziel-op-mvz-berlin.jpg 1200w\" data-sizes=\"auto\" data-orig-sizes=\"(max-width: 1200px) 100vw, 1200px\" \/><\/picture><\/p>\n<h3><span style=\"font-weight: 400;\"> <\/span><\/h3>\n<h3><b>Different forms of hiatal hernia<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Not every diaphragmatic hernia is the same. Doctors distinguish between   <\/span><b>Several forms of hiatal hernia<\/b><span style=\"font-weight: 400;\">  depending on the extent and location of the organ displacement. Essentially there are   <\/span>axial<span style=\"font-weight: 400;\"> (sliding) and <\/span>paraesophageal<span style=\"font-weight: 400;\"> (rolling) hernias, as well as mixed forms and special cases. The most important hernia types are: <\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h4><b>Axial sliding hernia (type I):<\/b><span style=\"font-weight: 400;\"> <\/span><\/h4>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">This is the most common form (over 90 % of cases, with <\/span><i><span style=\"font-weight: 400;\">glides<\/span><\/i><span style=\"font-weight: 400;\">  the transition from the esophagus to the stomach (cardia) upwards through the hiatus. The   <\/span>The entrance to the stomach and part of the stomach move into the chest cavity, while the esophagus slides up with it. This sliding hernia often leads to heartburn <span style=\"font-weight: 400;\">as the natural closure mechanism is disturbed. The displaced cardia can be seen in the chest cavity on an X-ray or gastroscopy. <\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h4><b>Paraesophageal hernia (roll hernia, type II):<\/b><span style=\"font-weight: 400;\"> <\/span><\/h4>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">More rarely, the stomach entrance occurs in its normal position, but <\/span>part of the stomach (usually the upper gastric fundus)<span style=\"font-weight: 400;\"> bulges <\/span><i><span style=\"font-weight: 400;\">next to<\/span><\/i><span style=\"font-weight: 400;\">  of the esophagus upwards through the diaphragm. This is called a &#8220;rolling&#8221; hernia because the stomach rolls next to the esophagus into the thorax while the cardia remains below. This form often initially causes    <\/span><span style=\"font-weight: 400;\">but can <\/span><span style=\"font-weight: 400;\"> cause mechanical problems &#8211; e.g. feelings of pressure or a risk of incarceration. Paraoesophageal hernias are less common, but are considered <\/span>more dangerous<span style=\"font-weight: 400;\"> because parts of the stomach can become trapped.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h4><b>Mixed hernia (type III):<\/b><span style=\"font-weight: 400;\"> <\/span><\/h4>\n<\/li>\n<\/ul>\n<p>In this case, elements of both of the above forms are present. Both the entrance to the stomach and a larger part of the stomach move into the chest cavity. There is therefore both a sliding part (axial) and a rolling part. Such mixed forms usually occur with larger hernias and can therefore cause both reflux symptoms and the risk of incarceration.   <\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h4><b>Rare type IV (large hernia):<\/b><span style=\"font-weight: 400;\"> <\/span><\/h4>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">In very pronounced cases, the hiatal opening is dilated to such an extent that <\/span>other organs<span style=\"font-weight: 400;\">  slide into the hernia sac. For example, loops of the intestine, the omentum and, more rarely, even the spleen or parts of the liver can move upwards. An extreme case is the    <\/span><b>&#8220;Thoracic stomach&#8221;<\/b><span style=\"font-weight: 400;\">in which almost the entire stomach is located in the chest cavity. Such large hernias (type IV) are rare, but are associated with   <\/span><b>severe symptoms<\/b><span style=\"font-weight: 400;\"> (shortness of breath, heart problems) and usually require prompt surgical treatment.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Schematic representation of different <\/span><b>types of hiatal hernia<\/b><span style=\"font-weight: 400;\"> (side view). <\/span> <\/p>\n<ul>\n<li><b>A<\/b><span style=\"font-weight: 400;\">normal anatomy without hernia (esophagus green, stomach pink remains completely under the diaphragm, purple line). <\/span> <\/li>\n<li><b>B<\/b><span style=\"font-weight: 400;\">: incipient displacement (preliminary stage), <\/span> <\/li>\n<li><b>C<\/b><span style=\"font-weight: 400;\">axial sliding hernia (cardia and upper stomach slide upwards), <\/span> <\/li>\n<li><b>D<\/b><span style=\"font-weight: 400;\">paraesophageal hernia (part of the stomach rolls next to the esophagus through the diaphragm). <\/span> <\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">In reality, mixed forms (combination of C and D) also occur.<\/span><\/p>\n<p><picture class=\"wp-picture-15026\" style=\"display: contents;\"><source type=\"image\/avif\" srcset=\"https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Unterschiedliche-Formen-der-Hiatushernie-venaziel-hernienzentrum-minimalinvasiv-op-berlin-jpg.avif 1000w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Unterschiedliche-Formen-der-Hiatushernie-venaziel-hernienzentrum-minimalinvasiv-op-berlin-250x109-jpg.avif 250w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Unterschiedliche-Formen-der-Hiatushernie-venaziel-hernienzentrum-minimalinvasiv-op-berlin-768x333-jpg.avif 768w\" sizes=\"(max-width: 1000px) 100vw, 1000px\"><img data-dominant-color=\"1a1617\" data-has-transparency=\"false\" style=\"--dominant-color: #1a1617;\" decoding=\"async\" class=\"lazyload alignnone size-full wp-image-15026 not-transparent\" src=\"https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Unterschiedliche-Formen-der-Hiatushernie-venaziel-hernienzentrum-minimalinvasiv-op-berlin.jpg\" data-orig-src=\"https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Unterschiedliche-Formen-der-Hiatushernie-venaziel-hernienzentrum-minimalinvasiv-op-berlin.jpg\" alt=\"Different-forms-of-hiatal-hernia-venaziel-hernia-center-minimally-invasive-op-berlin\" width=\"1000\" height=\"434\" title=\"\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%271000%27%20height%3D%27434%27%20viewBox%3D%270%200%201000%20434%27%3E%3Crect%20width%3D%271000%27%20height%3D%27434%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-srcset=\"https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Unterschiedliche-Formen-der-Hiatushernie-venaziel-hernienzentrum-minimalinvasiv-op-berlin-200x87.jpg 200w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Unterschiedliche-Formen-der-Hiatushernie-venaziel-hernienzentrum-minimalinvasiv-op-berlin-250x109.jpg 250w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Unterschiedliche-Formen-der-Hiatushernie-venaziel-hernienzentrum-minimalinvasiv-op-berlin-400x174.jpg 400w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Unterschiedliche-Formen-der-Hiatushernie-venaziel-hernienzentrum-minimalinvasiv-op-berlin-600x260.jpg 600w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Unterschiedliche-Formen-der-Hiatushernie-venaziel-hernienzentrum-minimalinvasiv-op-berlin-768x333.jpg 768w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Unterschiedliche-Formen-der-Hiatushernie-venaziel-hernienzentrum-minimalinvasiv-op-berlin-800x347.jpg 800w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/Unterschiedliche-Formen-der-Hiatushernie-venaziel-hernienzentrum-minimalinvasiv-op-berlin.jpg 1000w\" data-sizes=\"auto\" data-orig-sizes=\"(max-width: 1000px) 100vw, 1000px\" \/><\/picture><\/p>\n<p><span style=\"font-weight: 400;\"> <\/span><b>Good to know<\/b><\/p>\n<p><span style=\"font-weight: 400;\">In addition to acquired hiatal hernias (which develop in adulthood), there are very rare cases of <\/span><b>congenital diaphragmatic hernias<\/b><span style=\"font-weight: 400;\">  due to developmental disorders. One example is the   <\/span><b>Cardiofundal malposition<\/b><span style=\"font-weight: 400;\">  &#8211; where the stomach entrance is in the wrong place from birth (an anatomical anomaly). However, such cases are exceptional and often manifest themselves in infancy. At the Adult Hernia Center, we mainly deal with    <\/span><i><span style=\"font-weight: 400;\">acquired<\/span><\/i><span style=\"font-weight: 400;\"> hiatal hernias (type I-IV above).<\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><b>Causes and risk factors<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">A diaphragmatic hernia is usually caused by a <\/span>combination of tissue weakness and increased pressure in the abdominal cavity<span style=\"font-weight: 400;\">. Over the course of a lifetime, the connective tissue surrounding the opening in the diaphragm (hiatus) can weaken. If there is frequently high pressure in the abdominal cavity at the same time, the stomach is pushed upwards \u2013 a hiatal hernia develops.  The most important <\/span>Causes and risk factors<span style=\"font-weight: 400;\"> are:<\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Age and connective tissue weakness<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">With increasing age <\/span><i><span style=\"font-weight: 400;\">the tissue ligaments loosen<\/span><\/i><span style=\"font-weight: 400;\"> in the diaphragm. The tissue becomes weaker and more elastic, making the hiatus more prone to yielding. Therefore, hiatal hernias often occur in people over 50. A congenital connective tissue weakness (e.g., collagenoses) can also increase the risk.  <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Overweight (obesity)<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Severe obesity leads to chronically increased <\/span>abdominal pressure<span style=\"font-weight: 400;\">as a lot of fatty tissue pushes the organs upwards. Obesity (BMI &gt; 30) is a significant risk factor for hiatal hernias. Rapid weight gain also favors a hiatal hernia.  <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Pregnancy<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">During pregnancy, the growing uterus increases the abdominal volume and pushes the organs upwards. This increases the pressure on the diaphragm enormously. This can contribute to the formation of a hiatal hernia, especially in the last trimester. Multiple pregnancies further increase the risk.   <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Chronic pressing or lifting<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Activities or conditions that require regular heavy <\/span>pressing<span style=\"font-weight: 400;\">  promote a diaphragmatic hernia. These include   <\/span>Chronic constipation<span style=\"font-weight: 400;\"> (heavy pushing during bowel movements), <\/span>heavy lifting<span style=\"font-weight: 400;\">  at work or intensive strength training. Constantly carrying heavy loads also increases abdominal pressure. <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Chronic coughing and sneezing<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><b>Persistent cough<\/b><span style=\"font-weight: 400;\">  &#8211; such as chronic bronchitis, asthma or smoker&#8217;s cough &#8211; leads to frequent sudden increases in abdominal pressure. The same applies to   <\/span><b>allergic sneezing<\/b><span style=\"font-weight: 400;\"> over years. These stresses can gradually widen the diaphragmatic opening. Smokers are particularly at risk, as they often combine connective tissue weakness and coughing. <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Frequent or severe vomiting<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Repeated <\/span><b>vomiting<\/b><span style=\"font-weight: 400;\"> (e.g. in the case of eating disorders or stomach diseases) is an extreme strain on the diaphragm and can &#8211; like straining &#8211; promote a hernia.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In addition to these factors, in rare cases <\/span><b>Accidents or previous operations<\/b><span style=\"font-weight: 400;\">  on the diaphragm can lead to hernias (traumatic diaphragmatic hernias). In most cases, however, it is the   <\/span><i><span style=\"font-weight: 400;\">Long-term effect<\/span><\/i><span style=\"font-weight: 400;\">  of pressure and tissue weakness that leads to a diaphragmatic hernia. People with   <\/span><i><span style=\"font-weight: 400;\">Weak connective tissue<\/span><\/i><span style=\"font-weight: 400;\"> (e.g. due to genetic predisposition) should therefore exercise particular caution and reduce risk factors such as obesity as far as possible.<\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><b>Symptoms: How can you recognize a hiatal hernia?<\/b><\/h2>\n<p>Small hiatal hernias often go unnoticed<span style=\"font-weight: 400;\">, as they cause few symptoms. Many affected individuals discover their hiatal hernia by chance \u2013 for example, during a gastroscopy for another reason.  Larger hernias, however, can cause a range of symptoms, primarily due to <\/span>Heartburn (acid reflux)<span style=\"font-weight: 400;\">  are characterized. Typical   <\/span><i><span style=\"font-weight: 400;\">Hiatal hernia symptoms<\/span><\/i><span style=\"font-weight: 400;\"> are:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h3><b>Heartburn and acid regurgitation:<\/b><span style=\"font-weight: 400;\"> <\/span><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">This is the most common symptom. Stomach acid rises into the esophagus ( <\/span><b>Reflux due to diaphragmatic hernia<\/b><span style=\"font-weight: 400;\">), which causes a burning sensation behind the breastbone. It often intensifies when lying down or after a hearty meal. <\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h3><b>Pain in the upper abdomen or behind the breastbone:<\/b><span style=\"font-weight: 400;\"> <\/span><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Many patients complain of a dull feeling of pressure or pain in the upper abdominal area, sometimes radiating to the chest or back. Sometimes this pain is mistaken for heart problems. <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Difficulty swallowing (dysphagia)<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Especially with larger hernias, swallowing food can be difficult. This is either because the esophagus is kinked due to displacement, or because a part of the stomach is trapped next to the esophagus.  Affected individuals feel that <\/span><b>Food gets stuck<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Belching, bloating and flatulence<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">The altered anatomy leads to more frequent <\/span><b>air regurgitation<\/b><span style=\"font-weight: 400;\">. Many sufferers also report a rapid feeling of fullness after eating or a bloated stomach (bloating).<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\">\n<h3><b>Chronic cough or hoarseness:  <\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">The constant reflux of acid can irritate the airways. Nightly regurgitation of acid (silent reflux) often leads to   <\/span><b>Irritable cough<\/b><span style=\"font-weight: 400;\">throat clearing or hoarseness in the morning, as the vocal cords are irritated. Even asthma-like symptoms can be triggered by reflux. <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Shortness of breath and heart problems<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Very large hernias (e.g. thoracic stomach) can press on the lungs or heart. This manifests itself as   <\/span><b>Shortness of breath<\/b><span style=\"font-weight: 400;\">especially when lying down, or as a heart stumble. Such cases are rare but serious. Those affected often only eat small meals, as larger portions immediately trigger pressure in the chest.  <\/span><\/p>\n<p><span style=\"font-weight: 400;\"><strong>The important thing is:<\/strong> <\/span>The symptoms differ slightly depending on the type of hernia. In the case of an axial sliding hernia, heartburn and acid regurgitation are often the main symptoms, as the lower oesophageal sphincter no longer functions properly. With a paraesophageal hernia, on the other hand, patients are more likely to complain of a feeling of pressure, pain after eating or difficulty swallowing, while heartburn may be less pronounced.  <\/p>\n<p>Often there are no symptoms at all for a long time until symptoms suddenly arise due to a complication. For example, an initially silent hernia may only be noticed when an incarceration occurs. <\/p>\n<p><b>Note<\/b><\/p>\n<p><span style=\"font-weight: 400;\">As the symptoms are varied, a diaphragmatic hernia should be considered when <\/span>chronic heartburn<span style=\"font-weight: 400;\">  or unexplained chest\/upper abdominal pain &#8211; especially if risk factors such as obesity are present. A medical examination (e.g. by endoscopy) will provide certainty. <\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><b>Possible complications of a diaphragmatic hernia<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Untreated or large hiatal hernias can lead to serious complications over time <\/span>.<span style=\"font-weight: 400;\"> lead to. Therefore, it is important to take warning signs seriously. Here are the most important complications of a hiatal hernia: <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Chronic reflux and esophagitis<\/b><\/h3>\n<\/li>\n<\/ul>\n<p>The hiatal hernia often leads to permanent acid reflux. In the long term, this can cause inflammation of the esophageal mucosa (esophagitis). Signs of this are pain when swallowing and possibly difficulty swallowing. If the inflammation persists, ulcers and bleeding can occur in the oesophagus. The body also forms scar tissue, which can lead to a narrowing of the oesophagus<i>(stricture<\/i>) &#8211; you can then feel that food is slipping badly.    <\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Barrett&#8217;s esophagus (precancerous stage)<\/b><\/h3>\n<\/li>\n<\/ul>\n<p>Long-term, untreated reflux due to a hiatal hernia can cause the mucous membrane of the oesophagus to <i>remodel<\/i>. Doctors call this a Barrett&#8217;s oesophagus &#8211; the normal mucous membrane is replaced by intestine-like tissue. Barrett&#8217;s itself does not cause any noticeable symptoms, but is considered a precursor to oesophageal cancer, as the altered tissue can degenerate. People with chronic heartburn (over 5-10 years) are therefore advised to have regular gastroscopies to detect Barrett&#8217;s changes at an early stage.   <\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Stomach inflammation and ulcers (gastritis, ulcer)<\/b><\/h3>\n<\/li>\n<\/ul>\n<p>Parts of the stomach that are trapped in the hernia may be less well supplied with blood and more susceptible to inflammation. Acid can also accumulate in a hernia sac. This favors stomach ulcers or mucosal damage in the area of the hernia (so-called <i>Cameron lesions<\/i>). Such ulcers can bleed and lead to anemia. Signs would be black stools (tarry stools) or vomiting blood &#8211; in such a case, immediate medical attention is required.    <\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Incarceration (pinching)<\/b><\/h3>\n<\/li>\n<\/ul>\n<p>One of the most feared complications is acute incarceration of the stomach in the diaphragmatic hiatus. This mainly occurs with paraesophageal hernias or mixed forms. A part of the stomach is trapped in the hiatus so that neither food nor blood can pass through normally. Such a <i>strangulation<\/i> causes severe pain in the upper abdomen\/chest, nausea, vomiting and possibly signs of shock.   <\/p>\n<p>In the incarcerated part of the stomach, the blood supply can be cut off (ischemia), which would lead to the tissue dying off within a short time. An incarceration is an absolute emergency and must be treated surgically immediately. Fortunately, this rarely occurs, but in the case of large hernias there is a certain lifelong risk.  <\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Gastric torsion (volvulus) and intestinal obstruction<\/b><\/h3>\n<\/li>\n<\/ul>\n<p>In the case of very large diaphragmatic hernias, the stomach can twist in the hernia sac (gastric volvulus). A twisted stomach is no longer passable, resulting in an ileus (intestinal obstruction) with bloating, vomiting and acute pain. Parts of the intestine can also slip into a large hernia sac and become blocked. Such situations also require immediate surgery.   <\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Aspiration pneumonia<\/b><\/h3>\n<\/li>\n<\/ul>\n<p>Night-time reflux can cause tiny amounts of stomach acid to enter the airways (especially in older patients during sleep). This risk of aspiration is increased with severe reflux and can lead to chronic lung irritation or even pneumonia. Caution is required, especially if there is also a swallowing disorder.  <\/p>\n<p>As you can see, &#8220;simple&#8221; heartburn caused by a hiatal hernia can have serious long-term consequences. Early treatment (medical or surgical) therefore aims not only to relieve symptoms but also to prevent complications. Doctors advise proactive treatment, particularly for paraesophageal hernias, as there is a risk of incarceration here &#8211; even if there are few symptoms at first.  <\/p>\n<p>&nbsp;<\/p>\n<h2><b>Diagnosis: How is a hiatal hernia diagnosed?<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Several diagnostic procedures are available to clarify a suspected hiatal hernia <\/span><span style=\"font-weight: 400;\">  available. Often the   <\/span><i><span style=\"font-weight: 400;\">Medical history<\/span><\/i><span style=\"font-weight: 400;\"> (patient interview) and description of symptoms provide a clue. A physical examination can occasionally suggest a hiatal hernia (e.g., by palpating hernia sacs in large hernias, rarely palpable). However, imaging and endoscopic examinations provide certainty.  Typical <\/span><b>Diagnostic methods<\/b><span style=\"font-weight: 400;\"> are:<\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Gastroscopy (gastroscopy)<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">An <\/span><b>Endoscopy of the esophagus and stomach<\/b><span style=\"font-weight: 400;\"> is a central diagnostic tool. A flexible tube with a camera is inserted through the mouth. The doctor can directly see if the stomach entrance is above the diaphragm.  Often, a so-called <\/span>&#8220;Hernia orifice&#8221;<span style=\"font-weight: 400;\"> or a <\/span>displaced Z-line junction<span style=\"font-weight: 400;\">  (esophagus\/stomach junction). In addition   <\/span>Mucosal damage<span style=\"font-weight: 400;\">  due to reflux (e.g. oesophagitis, Barrett&#8217;s). Gastroscopy also allows samples (biopsies) to be taken if Barrett&#8217;s or inflammation is suspected. <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>X-rays with contrast medium (swallowed porridge)<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">A <\/span><b>X-ray sip<\/b><span style=\"font-weight: 400;\">  is a special X-ray procedure in which the patient drinks a contrast medium (barium slurry). X-ray images are taken while swallowing and afterwards. This makes it possible to see live whether contrast medium has entered a    <\/span><b>Hernia protrusion<\/b><span style=\"font-weight: 400;\">  flows. A hiatal hernia often manifests itself as   <\/span><b>Contrast-filled bulge<\/b><span style=\"font-weight: 400;\">  above the diaphragm. Also   <\/span><b>Movement disorders<\/b><span style=\"font-weight: 400;\"> of the esophagus and possible <\/span><b>constrictions<\/b><span style=\"font-weight: 400;\">  can be assessed. This procedure is painless and provides dynamic information on how large the hernia becomes under swallowing stress. <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Esophageal manometry (pressure measurement)<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">If necessary, a <\/span><b>Pressure measurement of the esophagus<\/b><span style=\"font-weight: 400;\">  is carried out. A thin probe measures the pressure from the throat to the stomach. Manometry can indicate whether the lower oesophageal sphincter is weakened and whether    <\/span><b>Coordination disorders<\/b><span style=\"font-weight: 400;\">  are present. It is less important for the diagnosis of the hernia itself, but it helps to rule out concomitant problems (e.g. achalasia). <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>24-hour pH-metry<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">This procedure measures the acid reflux into the esophagus over 24 hours <\/span><span style=\"font-weight: 400;\">. A small probe is inserted through the nose into the esophagus and connected to a portable recorder. The pH measurement shows how often and for how long   <\/span>Reflux episodes<span style=\"font-weight: 400;\"> occur and whether they correlate with symptoms. In cases of suspected hiatal hernia with atypical symptoms, this can serve to objectify reflux. pH-metry is often combined with manometry. <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Computed tomography (CT) or MRI<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">A <\/span><b>CT scan<\/b><span style=\"font-weight: 400;\">  of the chest and upper abdomen can help in unclear cases. It shows in great detail which organ parts are located where. Especially with    <\/span><i><span style=\"font-weight: 400;\">large hernias<\/span><\/i><span style=\"font-weight: 400;\"> or suspected incarceration, a CT scan is performed &#8211; e.g. if unclear structures are visible on the X-ray image or if there is an emergency. <\/span>Complications<span style=\"font-weight: 400;\">  such as gastric wall ischemia or volvulus formation can be detected by CT. An MRI is used less frequently, but can be used as an alternative in cases of contrast agent allergy or special issues. <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Sonography<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">An ultrasound examination of the abdomen or heart can provide indirect indications (e.g. <\/span>high stomach bladder<span style=\"font-weight: 400;\">  in the thorax). However, ultrasound is limited by bone\/air and plays a subordinate diagnostic role in hiatal hernias. <\/span><\/p>\n<p>In <span style=\"font-weight: 400;\">most cases, a gastroscopy combined with an X-ray of the stomach is sufficient <\/span><span style=\"font-weight: 400;\">to confirm the diagnosis of hiatal hernia and assess its extent. If necessary, further tests are carried out to   <\/span>reflux strength<span style=\"font-weight: 400;\"> (pH-metry) and <\/span>motility<span style=\"font-weight: 400;\"> (manometry), especially before a planned operation. It is also important to rule out other causes of symptoms &#8211; e.g. a heart attack in the case of chest pain or a stomach ulcer as the source of upper abdominal pain. Depending on the symptoms, the doctor will therefore also arrange for appropriate examinations (ECG, blood tests, etc.).<\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><b>When is an operation necessary?  <\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Not every <a href=\"https:\/\/de.wikipedia.org\/wiki\/Hiatushernie\" target=\"_blank\" rel=\"noopener\">hiatal hernia<\/a> needs to be operated on immediately. <\/span>Small, low-symptom hiatal hernias<span style=\"font-weight: 400;\"> can often be treated conservatively (i.e. without surgery) &#8211; e.g. with medication for heartburn and lifestyle changes. <\/span><span style=\"font-weight: 400;\"> However, <\/span>surgery is recommended or necessary if <span style=\"font-weight: 400;\"> there<\/span> are certain indications:<\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Pronounced symptoms despite therapy<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">If an axial sliding hernia <\/span>causes severe discomfort &#8211; especially chronic heartburn that persists despite medication (proton pump inhibitors, etc.) &#8211; surgical correction should be considered. Repeated oesophageal burning, pain or swallowing disorders<span style=\"font-weight: 400;\"> that impair quality of life are also a reason for surgery. Surgery is recommended for refractory reflux, especially in younger patients who do not want to take medication for the rest of their lives.<\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Paraesophageal hernia or mixed hernia with symptoms<\/b><\/h3>\n<\/li>\n<\/ul>\n<p>The<span style=\"font-weight: 400;\"> following applies <\/span><span style=\"font-weight: 400;\">to all types of hernia in which <\/span>parts of the stomach are located next to the oesophagus: surgery should be performed as soon as symptoms occur.<span style=\"font-weight: 400;\"> In particular, <\/span>chest and upper abdominal pain after eating, difficulty swallowing or a feeling of fullness<span style=\"font-weight: 400;\">  indicate that the stomach is partially obstructed. There is a high risk of incarceration here. Experts therefore recommend    <\/span>Symptomatic paraesophageal hernias should always be treated surgically<span style=\"font-weight: 400;\">. Also   <\/span><i><span style=\"font-weight: 400;\">Larger asymptomatic<\/span><\/i><span style=\"font-weight: 400;\"> paraesophageal hernias are often operated on preventively, as the probability of later complications is considerable.<\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Complications or their precursors<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">If the hiatal hernia has already <\/span>caused complications &#8211; such as bleeding, ulcers, severe esophagitis or even incarceration &#8211; surgery is indicated. For example, in Barrett&#8217;s oesophagus (as a result of chronic reflux), surgery is often advised to correct the reflux and stop the progression. Acute incarceration requires emergency surgery anyway. However, even without an acute emergency situation, the following applies: If ulcers or anemia<span style=\"font-weight: 400;\"> caused by the hernia are detected during diagnostics, surgery should be considered in order to prevent further damage.<\/span>   <\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Hernia enlargement<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Some initially small hiatal hernias become larger as they progress. If checks show that the hernia   <\/span>increases<span style=\"font-weight: 400;\"> &#8211; for example from a pure sliding hernia to a mixed form &#8211; prophylactic surgery may be advisable <\/span>, <i><span style=\"font-weight: 400;\">before<\/span><\/i><span style=\"font-weight: 400;\"> incarceration occurs.<\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Desire for a definitive solution<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Some patients opt for surgery <\/span><b>because they want a permanent solution<\/b><span style=\"font-weight: 400;\">. Younger, active people in particular often do not want to constantly take medication or accept dietary restrictions. A successful operation can solve the problem for good, which is an important aspect for many people. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Summarized: <\/span><b>Large hiatal hernias and those with symptoms usually require surgery<\/b><span style=\"font-weight: 400;\">, especially if parts of the stomach are located next to the esophagus (type II-IV). Small hiatal hernias (type I) without significant symptoms can be treated conservatively. Here, for example, the focus is on <\/span>reflux therapy with medication<span style=\"font-weight: 400;\"> (acid blockers, antacids) combined with measures such as weight loss and adjusting sleeping position. <\/span> <\/p>\n<p><span style=\"font-weight: 400;\">However, data show that even in the case of asymptomatic paraesophageal hernias, the <\/span><i><span style=\"font-weight: 400;\">preventive surgery<\/span><\/i><span style=\"font-weight: 400;\">  often makes sense, as the risk of a fatal complication (1-2% per year cumulative) is estimated to be higher than the risk of surgery. The decision should always be made individually with the patient &#8211; if in doubt, we at the Hernia Center Berlin will advise you in detail about the benefits and risks of a   <\/span><b>Diaphragmatic hernia surgery<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><b>Treating a hiatal hernia: Modern therapy methods<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">The treatment of a hiatal hernia depends <\/span>on the symptoms and the type of hernia<span style=\"font-weight: 400;\">. Basically there are  <\/span>Two therapeutic approaches<span style=\"font-weight: 400;\">: <\/span>conservative<span style=\"font-weight: 400;\"> (without surgery) and <\/span>surgical<span style=\"font-weight: 400;\">. Mild cases, especially axial hernias, can often be treated conservatively &#8211; with medication and lifestyle changes to reduce the risk of hernias.  <\/span><i><span style=\"font-weight: 400;\">Relieve reflux<\/span><\/i><span style=\"font-weight: 400;\">. However, if the hernia is larger or causes complications, there is usually no way around surgery.  <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Fortunately , modern, minimally invasive surgical methods are available today <\/span>.<span style=\"font-weight: 400;\">  which are very successful and gentle on the patient. In the following we explain the common   <\/span><b>Treatment options<\/b><span style=\"font-weight: 400;\">:<\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Conservative therapy (medication &amp; lifestyle)<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Smaller sliding hernias, which mainly cause <\/span><b>reflux symptoms<\/b><span style=\"font-weight: 400;\">  can initially be treated without surgery. The main pillars are   <\/span><b>Proton pump inhibitors (PPI)<\/b><span style=\"font-weight: 400;\"> such as omeprazole, which reduce stomach acid and thus relieve heartburn. Also <\/span><b>H2 blockers<\/b><span style=\"font-weight: 400;\"> or antacids can also be used. <\/span> <\/p>\n<p><span style=\"font-weight: 400;\"><strong>Also important are<\/strong> <\/span><b>Lifestyle measures<\/b><span style=\"font-weight: 400;\">: Weight loss for overweight individuals, avoiding late large meals, abstaining from alcohol\/nicotine (which worsen reflux), sleeping with the upper body slightly elevated, and avoiding straining or heavy lifting. These measures can significantly improve symptoms.  However, <\/span><i><span style=\"font-weight: 400;\">fix<\/span><\/i><span style=\"font-weight: 400;\">  the hernia itself &#8211; the hernia remains. Conservative treatment is therefore particularly suitable if the symptoms can be controlled and there is no high risk of complications. <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Laparoscopic surgery (keyhole surgery)<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">The standard treatment for surgical hiatal hernia correction today <\/span>is minimally invasive<span style=\"font-weight: 400;\"> via <\/span>laparoscopy<span style=\"font-weight: 400;\">. Through 4\u20135 small incisions (0.5\u20131 cm) in the abdominal wall, the surgeon inserts a camera and instruments.  The stomach is pulled back into the abdominal cavity, and the widened diaphragmatic opening is closed with sutures <\/span>tightly closed (hiatoplasty)<span style=\"font-weight: 400;\">. <\/span> <\/p>\n<p><span style=\"font-weight: 400;\">In addition, a <\/span>fundoplication<span style=\"font-weight: 400;\">  The upper part of the stomach (fundus) is loosely wrapped around the esophagus to create a valve against reflux. Laparoscopic procedures have the advantage of   <\/span>small scars, less pain and faster recovery<span style=\"font-weight: 400;\">. <\/span> <\/p>\n<p><span style=\"font-weight: 400;\">We use this technique routinely at our hernia center in Berlin. The procedure usually takes 60-90 minutes and is performed under general anesthesia. The patient can often leave the hospital after 1-3 days, in some cases even on the same day (outpatient hernia surgery).  <\/span><\/p>\n<ul>\n<li>\n<h3><strong>  Robot-assisted surgery (da Vinci system)<\/strong><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">A further development of keyhole surgery is the use of <\/span>surgical robots<span style=\"font-weight: 400;\"> such as the <\/span>da Vinci system<span style=\"font-weight: 400;\">. Here, the surgeon sits at a console and uses joysticks to control  <\/span><b>Robotic instruments<\/b><span style=\"font-weight: 400;\">that perform minimally invasive surgery in the patient. The robotic arms enable extremely precise movements and a 3D HD view. Complex hiatal hernias in particular can be treated excellently, as fine sutures on the diaphragm can be placed even more precisely.  <\/span><\/p>\n<p><picture class=\"wp-picture-14588\" style=\"display: contents;\"><source type=\"image\/avif\" srcset=\"https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/surgery-da-vinci-minimally-invasive-robotic-surgery-in-berlin-hernienzentrum-checkpoint-charlie-jpg.avif 1200w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/surgery-da-vinci-minimally-invasive-robotic-surgery-in-berlin-hernienzentrum-checkpoint-charlie-1024x512-jpg.avif 1024w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/surgery-da-vinci-minimally-invasive-robotic-surgery-in-berlin-hernienzentrum-checkpoint-charlie-768x384-jpg.avif 768w\" sizes=\"(max-width: 1200px) 100vw, 1200px\"><img data-dominant-color=\"96a9b2\" data-has-transparency=\"false\" style=\"--dominant-color: #96a9b2;\" decoding=\"async\" class=\"lazyload alignnone size-full wp-image-14588 not-transparent\" src=\"https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/surgery-da-vinci-minimally-invasive-robotic-surgery-in-berlin-hernienzentrum-checkpoint-charlie.jpg\" data-orig-src=\"https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/surgery-da-vinci-minimally-invasive-robotic-surgery-in-berlin-hernienzentrum-checkpoint-charlie.jpg\" alt=\"Robot-assisted minimally invasive surgery: a surgeon controls the instruments of the da Vinci surgical robot via the console (see image). This procedure enables particularly precise surgery for a hiatal hernia.\" width=\"1200\" height=\"600\" title=\"\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%271200%27%20height%3D%27600%27%20viewBox%3D%270%200%201200%20600%27%3E%3Crect%20width%3D%271200%27%20height%3D%27600%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-srcset=\"https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/surgery-da-vinci-minimally-invasive-robotic-surgery-in-berlin-hernienzentrum-checkpoint-charlie-200x100.jpg 200w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/surgery-da-vinci-minimally-invasive-robotic-surgery-in-berlin-hernienzentrum-checkpoint-charlie-250x125.jpg 250w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/surgery-da-vinci-minimally-invasive-robotic-surgery-in-berlin-hernienzentrum-checkpoint-charlie-400x200.jpg 400w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/surgery-da-vinci-minimally-invasive-robotic-surgery-in-berlin-hernienzentrum-checkpoint-charlie-600x300.jpg 600w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/surgery-da-vinci-minimally-invasive-robotic-surgery-in-berlin-hernienzentrum-checkpoint-charlie-768x384.jpg 768w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/surgery-da-vinci-minimally-invasive-robotic-surgery-in-berlin-hernienzentrum-checkpoint-charlie-800x400.jpg 800w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/surgery-da-vinci-minimally-invasive-robotic-surgery-in-berlin-hernienzentrum-checkpoint-charlie-1024x512.jpg 1024w, https:\/\/venaziel.de\/wp-content\/uploads\/2025\/04\/surgery-da-vinci-minimally-invasive-robotic-surgery-in-berlin-hernienzentrum-checkpoint-charlie.jpg 1200w\" data-sizes=\"auto\" data-orig-sizes=\"(max-width: 1200px) 100vw, 1200px\" \/><\/picture><\/p>\n<p><span style=\"font-weight: 400;\">At VenaZiel Hernia Center Checkpoint Charlie, we use this innovative technique to treat large or recurrent hernias, for example, with the utmost precision. For the patient, the procedure hardly differs from conventional laparoscopy &#8211; incisions and recovery time are minimal. <\/span><b>Incisions and recovery time remain minimal<\/b><span style=\"font-weight: 400;\">However, the operation is technically supported by the robot. Studies show that the results (reflux control, hernia tightness) with the da Vinci are at least as good, in some cases even better. <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Fundoplication (anti-reflux surgery)<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">The <\/span><b>Fundoplication according to Nissen<\/b><span style=\"font-weight: 400;\">  is a common component of hiatal hernia surgery. In this procedure, the upper stomach (fundus) is placed around the oesophagus &#8211; usually laparoscopically &#8211; and   <\/span><b>Cuff<\/b><span style=\"font-weight: 400;\">  fixed. This creates a new   <\/span><b>Valve mechanism<\/b><span style=\"font-weight: 400;\">which prevents reflux. A   <\/span><i><span style=\"font-weight: 400;\">360\u00b0 cuff<\/span><\/i><span style=\"font-weight: 400;\">  (complete wrapping) is called Nissen fundoplication. There are also partial cuffs (270\u00b0 Toupet or 180\u00b0 Dor), depending on the patient&#8217;s needs. A Nissen or Toupet fundoplication is included in most diaphragmatic hernia operations, as many patients suffer from heartburn.    <\/span><\/p>\n<p><span style=\"font-weight: 400;\">The fundoplication ensures that after the operation <\/span><b>no more gastric juice is released upwards<\/b><span style=\"font-weight: 400;\">  runs &#8211; the heartburn disappears completely in ~90 % of cases. Important: The fundoplication is always customized to avoid dysphagia (a cuff that is too tight could initially make swallowing difficult). <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Mesh implantation<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">In some cases &#8211; especially with <\/span><b>large hernia gaps or recurring hernias<\/b><span style=\"font-weight: 400;\"> &#8211; an additional <\/span><b>synthetic mesh<\/b><span style=\"font-weight: 400;\">  is inserted. This special plastic mesh (often made of polypropylene or PTFE) is placed over the closed hiatal hiatus and fixed to the diaphragm. It serves as a    <\/span><b>Reinforcement<\/b><span style=\"font-weight: 400;\">  of the weakened tissue to prevent it from coming apart again. The use of a mesh for hiatal hernias is somewhat controversial, as the mesh would be close to the esophagus. However, modern meshes and techniques reduce the risks (adhesions, erosions).    <\/span><\/p>\n<p><span style=\"font-weight: 400;\">We use meshes cautiously and only in necessary cases, such as huge hernias (thoracic stomach) or recurrences where the <\/span><b>risk of recurrence<\/b><span style=\"font-weight: 400;\">  is high. The study situation shows mixed results &#8211; in some situations, a net can improve the   <\/span><b>Recurrence of the hernia<\/b><span style=\"font-weight: 400;\">  significantly, in other cases there are hardly any advantages. The surgeon will discuss this with you in detail in advance. <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Open surgery<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Traditional open surgery (with an abdominal incision) is rarely necessary today, as minimally invasive methods have been perfected. Nevertheless, there are special cases in which a   <\/span><b>open procedure<\/b><span style=\"font-weight: 400;\"> is chosen: e.g. for <\/span><b>emergencies<\/b><span style=\"font-weight: 400;\">  with complicated incarceration or if adhesions after previous operations make laparoscopy difficult. Also with some   <\/span><b>High-risk patients<\/b><span style=\"font-weight: 400;\">where every minute counts are opened directly. <\/span> <\/p>\n<p><span style=\"font-weight: 400;\">Open procedures (e.g. via an incision in the upper abdomen or on the side of the ribcage) have similarly good chances of success, but are associated with a longer healing time. <\/span><b>longer healing time<\/b><span style=\"font-weight: 400;\">  and a larger scar. At our hernia center, we always check whether minimally invasive surgery is possible &#8211; over 95% of hiatal hernia operations can be performed laparoscopically. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">In addition, further measures may be useful in special cases, such as a <\/span><b>gastropexy<\/b><span style=\"font-weight: 400;\"> (attaching the stomach to the abdominal wall to prevent it from being pushed up again) or endoscopic therapy. <\/span><b>endoscopic therapy<\/b><span style=\"font-weight: 400;\">  (such as endoscopic fundoplication using the EsophyX device). However, these play less of a role in the standard procedure and are decided on an individual basis. <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Prospects of success<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Modern surgical methods for hiatal hernia are very successful. After a correctly performed operation, around   <\/span><b>90 % of patients are symptom-free<\/b><span style=\"font-weight: 400;\">  and no longer need reflux medication. The operation   <\/span><i><span style=\"font-weight: 400;\">Corrects both the anatomy and the reflux<\/span><\/i><span style=\"font-weight: 400;\">. <\/span> <\/p>\n<p><span style=\"font-weight: 400;\">Patient satisfaction is high, especially as the quality of life increases considerably without constant heartburn. Of course, every operation carries risks (bleeding, infection, injury to organs), but serious complications are rare with experienced hernia surgeons.   <\/span><\/p>\n<p><span style=\"font-weight: 400;\">The <\/span><b>mortality risk<\/b><span style=\"font-weight: 400;\">  for elective hiatal hernia surgery is less than 0.5%, for emergency surgery (incarceration) somewhat higher (~1-5%, depending on the study). Overall, the following applies   <\/span><b>Risks of the operation<\/b><span style=\"font-weight: 400;\"> are significantly lower than the possible complications of a large, untreated hernia.<\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><b>Course after the operation, aftercare and prognosis<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Hiatal hernia surgery is followed by the <\/span><b>recovery and aftercare phase<\/b><span style=\"font-weight: 400;\">  on. Thanks to minimally invasive techniques, the course of the operation today is usually   <\/span><b>Quick and uncomplicated<\/b><span style=\"font-weight: 400;\">. <\/span> <\/p>\n<h3><b>What can you expect after the operation?<\/b><\/h3>\n<ul>\n<li aria-level=\"1\">\n<h4><b>Hospitalization<\/b><\/h4>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Most patients only stay in hospital for a short time after a planned hiatal hernia operation. <\/span><b>briefly in hospital<\/b><span style=\"font-weight: 400;\">. For laparoscopic procedures, the observation time is often  <\/span><b>1-3 days<\/b><span style=\"font-weight: 400;\">, depending on individual well-being. Some smaller procedures can even be performed on an outpatient basis or with one overnight stay.  For open surgeries, the stay is longer (approx. 5\u20137 days). <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Immediately after the operation, you will spend a few hours in the recovery room. As soon as you are awake and stable, you may drink light fluids. <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h4><b>Pain and wound healing<\/b><\/h4>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Postoperative pain is usually <\/span><b>moderate<\/b><span style=\"font-weight: 400;\">. Due to the small incisions, many patients only experience a feeling of pressure or muscle ache in the shoulder area (from the gas used for the laparoscopy).  <\/span><\/p>\n<p><span style=\"font-weight: 400;\">You receive needs-based <\/span><b>painkillers<\/b><span style=\"font-weight: 400;\">, often paracetamol or ibuprofen are sufficient. The incisions are closed with self-dissolving sutures or staple strips.  After ~10\u201314 days, a wound check takes place (if necessary, removal of sutures, if not self-dissolving). <\/span><\/p>\n<p><span style=\"font-weight: 400;\">It is normal if swallowing is a little uncomfortable in the first few days or if you feel a lump &#8211; this is due to swelling caused by the fundoplication. These symptoms will subside in 1-2 weeks. <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h4><b>Nutrition in the early phase<\/b><\/h4>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Immediately after the operation, the diet is slowly increased. Usually you start on the 1st day with   <\/span><b>Water, tea and clear broth<\/b><span style=\"font-weight: 400;\">. If the patient tolerates this, the following day  <\/span><b>Pureed food or porridge<\/b><span style=\"font-weight: 400;\">. <\/span> <\/p>\n<p><span style=\"font-weight: 400;\">In the following days you increase to <\/span><b>soft food<\/b><span style=\"font-weight: 400;\">  (e.g. mashed potatoes, yogurt, soft vegetables). Smaller portions, chewing well and eating slowly are important.   <\/span><b>Carbonated drinks<\/b><span style=\"font-weight: 400;\"> should be avoided at first, as burping can be difficult (the new cuff makes it harder to burp or vomit at first). <\/span> <\/p>\n<p><span style=\"font-weight: 400;\">After about <\/span><b>2-3 weeks<\/b><span style=\"font-weight: 400;\"> most patients are allowed to resume <\/span><i><span style=\"font-weight: 400;\">normal food<\/span><\/i><span style=\"font-weight: 400;\">  to eat. Your doctor will give you precise dietary guidelines.   <\/span><b>Weight loss<\/b><span style=\"font-weight: 400;\">Many patients lose a small amount of weight (2-5 kg) as a result of the initial diet, which is entirely desirable and supports the healing process.<\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h4><b>Everyday life and protection<\/b><\/h4>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">In the first <\/span><b>4-6 weeks after the operation<\/b><span style=\"font-weight: 400;\"> you should <\/span><b>avoid heavy physical exertion<\/b><span style=\"font-weight: 400;\">. Do not lift anything heavier than approx. 5 kg (no heavy lifting\/carrying) so as not to strain the fresh suture on the diaphragm. You should also avoid pushing hard (during bowel movements) &#8211; make sure your stool is soft (drink enough, possibly take a mild laxative as a preventative measure).   <\/span><\/p>\n<p><b>Physical protection<\/b><span style=\"font-weight: 400;\">  However, this does not mean bed rest: light exercise such as walking is expressly encouraged as soon as you feel up to it. We will mobilize you carefully the day after the operation.   <\/span><\/p>\n<p><b>Career break:<\/b><span style=\"font-weight: 400;\">  Depending on your profession, you will be unable to work for about 2-4 weeks. Office work can often be resumed after 2 weeks, physical occupations after 4-6 weeks (please discuss this with your doctor). <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h4><b>Follow-up check<\/b><\/h4>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">We arrange several follow-up appointments. Shortly after discharge, an initial check-up takes place (wound healing, symptoms, diet). Later \u2013 usually after ~6 weeks \u2013 a comprehensive check-up is performed.   We check whether <\/span><b>all symptoms are eliminated<\/b><span style=\"font-weight: 400;\"> and how the swallowing works. <\/span> <\/p>\n<p><span style=\"font-weight: 400;\">If necessary, an <\/span><b>endoscopy<\/b><span style=\"font-weight: 400;\"> or X-ray examination is performed to verify the situation. <\/span><b>In the long term<\/b><span style=\"font-weight: 400;\">  annual check-ups are advisable, especially if complications such as Barrett&#8217;s esophagus have previously occurred. In patients with no symptoms and no special features, the GP can take over further care.   <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Should <\/span><b>symptoms recur<\/b><span style=\"font-weight: 400;\"> recur (e.g. recurring heartburn after years), you should present earlier &#8211; it could be a small recurrence. <\/span><b>recurrence<\/b><span style=\"font-weight: 400;\"> which can be dealt with more easily in the early stages.<\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h4><b>Forecast<\/b><\/h4>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">The prospects after hiatal hernia surgery are <\/span><b>very good<\/b><span style=\"font-weight: 400;\">. The vast majority of patients report a significantly improved quality of life, as agonizing heartburn, pain or feelings of pressure have disappeared.  <\/span><\/p>\n<p><span style=\"font-weight: 400;\">As mentioned, the success rate (permanent absence of reflux) is around <\/span><b>90 %<\/b><span style=\"font-weight: 400;\">. Some patients may occasionally experience mild heartburn, usually after very substantial meals &#8211; this can often be well controlled with on-demand medication.  <\/span><b>Difficulty swallowing<\/b><span style=\"font-weight: 400;\"> may be present in the first few weeks, but usually disappear completely as soon as the cuff has settled.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In rare cases, a certain sensitivity remains when swallowing large bites (in this case it helps to eat slowly and chew well).<\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h4><b>Recurrence rate<\/b><\/h4>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Despite careful surgery, a small number of patients may experience a recurrence of the hernia over the years. <\/span><b>recurrence of the hernia<\/b><span style=\"font-weight: 400;\"> occur. Studies show recurrence rates of about 5\u201315% after 10 years, depending on hernia size and risk factors. A recurrence means that tissue slides through the diaphragm again.  However, not every recurrence causes symptoms. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">If symptoms do reoccur, a second operation can be performed, provided this is justifiable. <\/span><b>renewed operation<\/b><span style=\"font-weight: 400;\">  often minimally invasive. Thanks to improved techniques (e.g. reinforcement with mesh if necessary), second operations are also successful today. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Overall, the <\/span><b>prognosis of hiatal hernia<\/b><span style=\"font-weight: 400;\"> is excellent, <\/span><b>if it is treated adequately<\/b><span style=\"font-weight: 400;\">. If left untreated, a large hernia would very likely lead to increasing discomfort and possible emergencies. With modern surgery, on the other hand, patients who have undergone surgery can   <\/span><i><span style=\"font-weight: 400;\">a normal life without major restrictions<\/span><\/i><span style=\"font-weight: 400;\">  lead. It is important to follow the aftercare recommendations and maintain a healthy lifestyle in order not to jeopardize the results of the operation. <\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><b>Recommendations for diet, behavior and exercise after treatment<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">After treatment &#8211; whether conservative or surgical &#8211; patients can contribute a great deal to the success of their treatment through their own behavior. Here are some   <\/span><b>Practical recommendations<\/b><span style=\"font-weight: 400;\"> for everyday life after hiatal hernia treatment:<\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Gradual diet build-up after surgery<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">As mentioned above, after an operation, there is initially a phase with liquid and soft food. Strictly follow your doctor&#8217;s diet plan.  In the first few weeks, it is important to <\/span><i><span style=\"font-weight: 400;\">several small meals<\/span><\/i><span style=\"font-weight: 400;\">  better than a few large ones. Avoid eating in a hurry &#8211;   <\/span><b>Chew well<\/b><span style=\"font-weight: 400;\">  and swallow slowly so that there is little pressure on the oesophagus. After about a month, you can usually eat everything you can tolerate again. <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Low reflux diet<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Irrespective of surgery, it makes sense to follow the principles of a low-reflux diet, especially if heartburn still occurs occasionally. This means   <\/span><b>Avoid high-fat, very rich meals<\/b><span style=\"font-weight: 400;\">, as well as heavily spiced, hot foods. Citrus fruits, coffee, alcohol, and chocolate can promote reflux in sensitive individuals \u2013 carefully test what you tolerate.  In general, are <\/span><b>protein-rich, low-fat foods<\/b><span style=\"font-weight: 400;\"> favorable (lean meat, fish, vegetables, easily digestible food).<\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Take evening meals on time<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Eat at least <\/span><b>2-3 hours before going to bed<\/b><span style=\"font-weight: 400;\"> your last meal. Do not go to bed with a full stomach. This allows digestion to begin, and less acid returns. If nocturnal reflux was an issue, consider sleeping with your upper body slightly elevated (e.g., a wedge pillow or adjustable slatted frame).  <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Keeping an eye on body weight<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Reduce <\/span><b>Overweight<\/b><span style=\"font-weight: 400;\">because every kilo less relieves the pressure on the abdomen. Many patients already lose weight after surgery &#8211; try to maintain this trend. A BMI in the normal range not only reduces reflux, but also the risk of something pushing through again.  <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>No heavy lifting at the beginning<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">In the first 6 weeks after surgery you should strictly <\/span><b>avoid heavy loads<\/b><span style=\"font-weight: 400;\">. Do not lift anything over ~5 kg. The following also applies later on: Avoid long-term extreme loads. If your job is physically demanding, discuss with your doctor when you can return to full work. Gradual reintegration may be advisable.   <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Encourage moderate exercise<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Start early with <\/span><b>light exercise<\/b><span style=\"font-weight: 400;\">to get your circulation and digestion going. Walks are good from the 2nd day post-op. After 2-3 weeks, you can usually start with moderate exercise: e.g. light cycling (without pushing hard), gymnastics, physiotherapy for core stability. However, avoid exercises that make heavy use of the abdominal press (strength training, heavy trunk flexion) for about 2 months. <\/span><b>After about 3 months<\/b><span style=\"font-weight: 400;\"> most patients can resume unrestricted sporting activities &#8211; provided they have been cleared by their doctor.<\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Listen to your body<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Watch out for warning signs. If heartburn recurs regularly despite all measures, do not hesitate to consult a doctor. The same applies to swallowing problems, pain or other unusual symptoms. It is better to check early on whether everything is in order.   <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Continue to live smoke-free<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">If you were a smoker, use the success of your treatment as motivation, <\/span><b>smoke-free<\/b><span style=\"font-weight: 400;\"> to remain. Nicotine weakens the esophageal sphincter and promotes acid production \u2013 quite apart from the general health risks. Patients who quit smoking often report significantly fewer reflux symptoms. <\/span><\/p>\n<ul>\n<li aria-level=\"1\">\n<h3><b>Keeping aftercare appointments<\/b><\/h3>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Follow the recommended check-ups. Especially if you have had Barrett&#8217;s esophagus, regular endoscopies are important, even if you are symptom-free. Your doctor will set a suitable schedule with you (often a Barrett&#8217;s gastroscopy every 1-3 years for early detection of changes).  <\/span><\/p>\n<p><span style=\"font-weight: 400;\">These measures will help you to heal and prevent relapses. Many of the points mentioned &#8211; such as diet and weight normalization &#8211; are also beneficial for general health.   <\/span><b>Our goal at the Hernia Center Berlin<\/b><span style=\"font-weight: 400;\"> is not only to operate on you successfully, but also to support you in the <\/span><b>phase afterwards<\/b><span style=\"font-weight: 400;\">so that you benefit from the operation in the long term.<\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><b>Conclusion<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Hiatal hernia (diaphragmatic hernia) is easily treatable. Thanks to modern minimally invasive techniques &#8211; including robot-assisted surgery &#8211; we are able to   <\/span><b>VenaZiel Hernia Center Berlin<\/b><span style=\"font-weight: 400;\">  can gently repair almost any hernia. It is important to take the condition seriously: Even if many diaphragmatic hernias appear harmless at first, they can lead to reflux and other problems.   <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Do not hesitate to seek medical advice if you suffer from chronic heartburn or upper abdominal pain. With the right treatment &#8211; be it conservative or surgical &#8211; you will usually get rid of your symptoms completely and be able to enjoy your life again.   <\/span><i><span style=\"font-weight: 400;\">Go through life without complaints<\/span><\/i><span style=\"font-weight: 400;\">. If you have any questions, please contact our  <\/span><b>Special consultation for hiatal hernias<\/b><span style=\"font-weight: 400;\"> at Checkpoint Charlie.<\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><b>FAQ &#8211; Frequently asked questions from patients about hiatal hernia<\/b><\/h2>\n<h3><b>Does every hiatal hernia require surgery?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">No.  <\/span><b>Small hiatal hernias<\/b><span style=\"font-weight: 400;\">  without or with mild symptoms do not necessarily require surgery. Often a   <\/span><a href=\"https:\/\/venaziel.de\/en\/hernienzentrum\/\" target=\"_blank\" rel=\"noopener\"><b>Conservative treatment<\/b><\/a><span style=\"font-weight: 400;\">  with medication (for heartburn) and lifestyle adjustments. Surgery is particularly recommended if   <\/span><b>severe complaints<\/b><span style=\"font-weight: 400;\"> exist or a <\/span><b>dangerous type of hernia<\/b><span style=\"font-weight: 400;\"> (e.g. paraesophageal) is present. <\/span> <\/p>\n<p><span style=\"font-weight: 400;\">In particular a <\/span><b>paraesophageal hernia<\/b><span style=\"font-weight: 400;\">  should be operated on if you have symptoms, as there is a risk of incarceration. Your doctor will assess with you individually whether surgery is necessary. Note: Not every diaphragmatic hernia needs an operation &#8211; but    <\/span><b>Every large or problematic fracture should be examined by a specialist<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h3><b>How is a diaphragmatic hernia diagnosed?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">The <\/span><b>diagnosis<\/b><span style=\"font-weight: 400;\"> is usually made by means of <\/span><b>gastroscopy (gastroscopy)<\/b><span style=\"font-weight: 400;\"> and\/or an <\/span><b>X-ray broad swallow<\/b><span style=\"font-weight: 400;\">. During the endoscopy, the doctor can see directly whether parts of the stomach have slipped upwards. The X-ray wide swallow shows the   <\/span><b>Size and shape<\/b><span style=\"font-weight: 400;\"> of the hernia in real time. <\/span> <\/p>\n<p><span style=\"font-weight: 400;\">In addition, a <\/span><b>pH-metry<\/b><span style=\"font-weight: 400;\"> (measurement of acid reflux) and <\/span><b>manometry<\/b><span style=\"font-weight: 400;\"> (pressure measurement) can be carried out to assess the influence of the hernia on the reflux. <\/span><span style=\"font-weight: 400;\">In unclear cases, a <\/span><b>CT SCAN<\/b><span style=\"font-weight: 400;\">e.g. in cases of suspected incarceration. In most cases, however, endoscopy + X-ray are sufficient for the diagnosis.<\/span><\/p>\n<h3><b>Can a hiatal hernia cause heartburn?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Yes, that is <\/span><b>very common<\/b><span style=\"font-weight: 400;\">  the case. The diaphragmatic hernia causes the   <\/span><b>Closing mechanism at the stomach entrance<\/b><span style=\"font-weight: 400;\">  weakened because the lower esophageal sphincter is displaced upwards into the chest cavity. This allows stomach acid to easily flow back into the oesophagus, resulting in   <\/span><b>Heartburn (reflux)<\/b><span style=\"font-weight: 400;\">. Especially the   <\/span><b>Axial sliding hernia<\/b><span style=\"font-weight: 400;\"> often causes severe heartburn. <\/span> <\/p>\n<p><span style=\"font-weight: 400;\">Many patients first notice their diaphragmatic hernia because they have <\/span><b>chronic acid regurgitation<\/b><span style=\"font-weight: 400;\">  have. In other forms of hernia (paraesophageal), heartburn may also be absent, in which case the focus is on mechanical symptoms.  Overall:  <\/span><b>Reflux and hiatal hernia<\/b><span style=\"font-weight: 400;\"> often occur together &#8211; up to 90% of people with chronic reflux have a (usually small) hiatal hernia.<\/span><\/p>\n<h3><b>How does the operation for a hiatal hernia work?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">In most cases, the operation is <\/span><b>minimally invasive (laparoscopic)<\/b><span style=\"font-weight: 400;\">  performed. The patient is given general anesthesia. The surgeon inserts a camera and fine instruments through small incisions. First the     <\/span><b>the displaced part of the stomach is retracted into the abdominal cavity<\/b><span style=\"font-weight: 400;\">. Then the   <\/span><b>Diaphragmatic gap reduced<\/b><span style=\"font-weight: 400;\">, usually by several sutures in the area of the hiatus (this is called hiatoplasty). If necessary, a small mesh is attached for reinforcement.  Subsequently, the surgeon often forms a <\/span><b>Fundoplication<\/b><span style=\"font-weight: 400;\"> &#8211; i.e. a <\/span><b>gastric sleeve around the esophagus<\/b><span style=\"font-weight: 400;\">to improve the closing mechanism. Once everything is in place, the instruments are removed and the small incisions are closed.   <\/span><\/p>\n<p><span style=\"font-weight: 400;\">The operation usually takes 1-2 hours. In difficult cases or emergencies   <\/span><b>Open surgery<\/b><span style=\"font-weight: 400;\">  (longer abdominal incision), but this is rare. After the operation, you wake up from the anesthetic and remain under observation. Overall, the    <\/span><b>procedures very safely and routinely<\/b><span style=\"font-weight: 400;\"> in specialized centers.<\/span><\/p>\n<h3><b>What are the risks of hiatal hernia surgery?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">As with any operation, there are certain <\/span><b>risks<\/b><span style=\"font-weight: 400;\">. These include:  <\/span><b>Injury to neighboring organs<\/b><span style=\"font-weight: 400;\"> (esophagus, stomach, rarely spleen) &#8211; but very unlikely with experienced surgeons. <\/span><b>Bleeding<\/b><span style=\"font-weight: 400;\">  or secondary bleeding can occur, but can usually be controlled. Infections in the wound area or in the abdominal cavity (peritonitis) are rare, as the procedure is minimally invasive and the gastrointestinal tract is not opened. Specifically, the following can occur after fundoplication    <\/span><b>Difficulty swallowing<\/b><span style=\"font-weight: 400;\">  can occur if the cuff is too tight &#8211; this can be remedied by endoscopic dilation or, in rare cases, re-operation. It is very rare for the cuff to slip down again prematurely or for a   <\/span><b>Recovering hernia<\/b><span style=\"font-weight: 400;\"> elsewhere. <\/span> <\/p>\n<p><span style=\"font-weight: 400;\">Thromboses or pulmonary embolisms are general surgical risks, and prophylactic injections are given to prevent these. The   <\/span><b>Mortality rate<\/b><span style=\"font-weight: 400;\">  for a planned hiatal hernia operation is extremely low (&lt;&lt;1%). Overall, the operation is considered safe. Your surgeon will go through all the risks and complications with you in the consultation.  <\/span><\/p>\n<h3><b>How long does it take to heal after the operation?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">The <\/span><b>initial healing<\/b><span style=\"font-weight: 400;\"> of the internal sutures on the diaphragm takes about <\/span><b>6 weeks<\/b><span style=\"font-weight: 400;\">. During this time, you should rest (no heavy loads, as described above). The small skin incisions heal superficially within ~2 weeks.  Many patients feel already <\/span><b>quite fit after 1-2 weeks<\/b><span style=\"font-weight: 400;\">, especially with laparoscopic surgery, and can resume lighter activities. Full load-bearing capacity (sports, lifting) is usually possible after   <\/span><b>8-12 weeks<\/b><span style=\"font-weight: 400;\">  again when the scars are stable. It is important to build up the diet slowly &#8211; after approx.   <\/span><b>4 weeks<\/b><span style=\"font-weight: 400;\"> you can eat normally again if everything has healed well.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A certain <\/span><b>caution when swallowing<\/b><span style=\"font-weight: 400;\">  (chew well, small bites) is advisable for about 2-3 months until everything has healed internally soft and scarred. Your doctor will usually recommend a   <\/span><b>Follow-up appointment ~6 weeks<\/b><span style=\"font-weight: 400;\"> post-op to check the healing process. Many report that they almost forget they had surgery from then on \u2013 except that the heartburn is gone. <\/span><\/p>\n<h3><b>Can a hiatal hernia come back?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Yes, in principle there is the possibility of a <\/span><b>recurrence<\/b><span style=\"font-weight: 400;\">  (recurrence). Despite careful surgery, a diaphragmatic hernia can recur in around 10% of patients within 5-10 years. Reasons can be    <\/span><b>Tissue weakness<\/b><span style=\"font-weight: 400;\"> (the original cause persists), <\/span><b>persistent high pressure<\/b><span style=\"font-weight: 400;\"> (e.g. heavy pressing, renewed weight gain) or, in a few cases, failure of the <\/span><b>failure of the material<\/b><span style=\"font-weight: 400;\"> (suture tears). <\/span> <\/p>\n<p><span style=\"font-weight: 400;\">However, not every small recurrent hernia directly leads to symptoms. Many recurrences are asymptomatic and are only discovered by chance.  However, if symptoms <\/span><b>Symptoms<\/b><span style=\"font-weight: 400;\">  (recurring heartburn, feeling of pressure), this should be clarified. Minor recurrences can initially be treated conservatively. In the case of larger or symptomatic recurrences, a    <\/span><b>Revision surgery<\/b><span style=\"font-weight: 400;\">  This is often minimally invasive, sometimes also robot-assisted. The chances of success of a second operation are also good, although somewhat lower than with a primary operation. After the first operation, it is important to   <\/span><b>Minimize risk factors<\/b><span style=\"font-weight: 400;\"> (no smoking, normal weight, no heavy lifting) in order to prevent a recurrence as far as possible.<\/span><\/p>\n<h3><b>What can I do myself to alleviate the symptoms?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">A few things! Especially for mild heartburn caused by hiatal hernia   <\/span><b>Lifestyle changes<\/b><span style=\"font-weight: 400;\"> can achieve a lot. <\/span><b>Losing weight<\/b><span style=\"font-weight: 400;\"> is the be-all and end-all if you are overweight &#8211; just 5-10 kg less can significantly improve reflux. <\/span><b>Eat a reflux-friendly diet:<\/b><span style=\"font-weight: 400;\"> Eat less fat, don&#8217;t eat too much at once, eat early and lighter in the evening. Avoid triggers such as alcohol, nicotine, coffee in excess. Sleep with your head elevated if nocturnal heartburn is bothering you.   <\/span><b>Avoid pressing<\/b><span style=\"font-weight: 400;\"> \u2013 treat constipation early (fiber, drink plenty of fluids). Lift heavy objects from your knees, not from your back with breath-holding. For acute complaints, over-the-counter antacids (such as Maaloxan) can provide short-term relief \u2013 but for longer-lasting problems, please see a doctor.   <\/span><\/p>\n<p><b>Physiotherapy<\/b><span style=\"font-weight: 400;\"> or special breathing exercises can strengthen the diaphragm muscles and thereby provide indirect support. Ultimately, through a healthy lifestyle, you can ensure that the  <\/span><b>Hiatal hernia causes as few symptoms as possible<\/b><span style=\"font-weight: 400;\">. Although this does not replace any necessary surgery, it can delay the time or make an operation superfluous if the symptoms disappear.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A hiatal hernia is a common condition in which parts of the stomach protrude through a natural opening in the diaphragm (hiatus esophagus) into the chest cavity. This can lead to heartburn (reflux) and other symptoms, as the entrance to the stomach is no longer held in its normal place under the diaphragm.   <\/p>\n<p>In many cases, a diaphragmatic hernia goes unnoticed for a long time, but larger hernias can cause significant symptoms and increase the risk of complications.  <\/p>\n","protected":false},"author":1,"featured_media":14721,"parent":14386,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-14992","page","type-page","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/pages\/14992","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/comments?post=14992"}],"version-history":[{"count":12,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/pages\/14992\/revisions"}],"predecessor-version":[{"id":58937,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/pages\/14992\/revisions\/58937"}],"up":[{"embeddable":true,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/pages\/14386"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/media\/14721"}],"wp:attachment":[{"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/media?parent=14992"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}