Hiatal hernia

A sliding hernia does not represent a separate hernia location but rather a specific anatomical form of hernia, most commonly inguinal. Depending on the organ involved in forming the hernia sac, the following types are distinguished:

1. Sliding hernia involving the large intestine

• most commonly involves the cecum (on the right side),
• may involve the sigmoid colon (on the left side),
• a portion of the intestine forms the posterior wall of the hernia sac.

2. Sliding hernia involving the urinary bladder

• more frequently observed in men with prostate enlargement,
• can cause urination disorders,
• a portion of the bladder wall moves into the inguinal canal.

3. Rare forms

• involving the ovary (in women),
• involving other retroperitoneal structures.

Most commonly, a sliding hernia develops in the area of:

• an oblique inguinal hernia,
• less frequently – a direct inguinal hernia.

Factors contributing to its development include:

• chronic increase in intra-abdominal pressure (cough, constipation, lifting),
• weakening of the abdominal walls,
• age over 50 years,
• obesity.

From a surgical perspective, the fact that the hernia sac wall is not separated from the organ is of critical importance, as it increases the risk of organ damage during surgery.

The symptoms of a sliding hernia are similar to a classic inguinal hernia, but they can be more varied depending on the organ involved in the process.

Most common general symptoms:

• Bulging in the groin, which intensifies with coughing or exertion,
• A feeling of pulling, discomfort, or pain,
• Enlargement of the bulge when standing.

If the large intestine is involved, the following may occur:

• Bloating,
• Feeling of incomplete evacuation,
• Periodic constipation.

In cases involving the bladder, characteristic symptoms include:

• Double urination (so-called biphasic micturition),
• Feeling of incomplete bladder emptying,
• Frequent urination.

Complications may include:

• Hernia incarceration – sudden, severe pain, inability to reduce the contents,
• Bowel obstruction,
• Organ ischemia.

Diagnostics include:

• Clinical examination,
• Groin ultrasound,
• In selected cases, computed tomography (CT), especially if bladder involvement is suspected.

It is worth noting that the absence of pain does not exclude the presence of a sliding hernia – the condition can remain asymptomatic for a long time.

The only effective method for treating a sliding hernia is surgical treatment. Conservative management (e.g., hernia belts) does not eliminate the anatomical problem and does not prevent complications.

Methods of surgical treatment include:

1. Classic surgery (open method)
   • repositioning of the organ,
   • strengthening of the inguinal canal wall,
   • use of a synthetic mesh (tension-free technique).
2. Laparoscopic treatment (TAPP, TEP)
   • less invasiveness,
   • shorter recovery time,
   • good visualization of anatomical structures.

In the case of a sliding hernia, the surgery requires:

• precise identification of the organ forming the sac wall,
• careful dissection,
• the operator's experience in hernia surgery.

Indications for urgent surgery:

• symptoms of incarceration,
• intestinal obstruction,
• symptoms of ischemia.

Recovery usually takes:

• 2–4 weeks for classic surgery,
• 1–2 weeks after laparoscopic surgery (with an uncomplicated course).

Recurrence prevention includes:

• weight reduction,
• treatment of constipation,
• avoiding excessive physical exertion in the postoperative period,
• control of diseases causing chronic cough.

Modern hernia surgery, based on tension-free techniques using synthetic meshes, is characterized by a low recurrence rate (below 5% in referral centers). However, appropriate patient qualification and the experience of the surgical team are of key importance.