Hiatal / Paraesophageal Hernia


A hiatal hernia is different from other hernias because it results in weakness of a natural and necessary defect in the diaphragm where the esophagus exits the chest and enters the abdomen. It is a condition in which part of the stomach pushes up into the chest cavity through an opening in the diaphragm called the hiatus. The hiatus is the place where the stomach and esophagus connect. When the stomach pushes through this opening due to a weakness in the diaphragm, a hiatal hernia results.

Hiatal hernias may cause reflux, or back flow, of acid from the stomach into the esophagus, resulting in varying degrees of discomfort or distress. This back flow of acid is called gastroesophageal reflux disease, commonly known as GERD. Surgical repair is necessary if nonsurgical treatments are ineffective or symptoms exacerbate. A hiatal hernia, like any hernia, can become serious if it becomes incarcerated (trapped) or strangulated, where blood flow is cut off and tissue dies. In either of these cases, emergency surgery is necessary.

Causes of a Hiatal Hernia

While some hiatal hernias are congenital, causing gastroesophageal reflux in infants, hiatal hernias are most common in people 50 years of age and older. A hiatal hernia may result from age-related weakening of the supportive tissue at the juncture of the esopha-gus and stomach. Risk factors that increase the chances of hiatal hernia development are:

  • Increasing age
  • Obesity
  • Smoking
  • Injury to the area
  • Unusually large hiatus from birth
  • Hard or persistent coughing or sneezing,vomiting or straining

Symptoms of a Hiatal Hernia

When the defect is too large, you may experience reflux or heartburn. Sometimes the stomach bulges up into the chest and can also cause regurgitation of food, difficulty swallowing, shortness of breath, or vomiting.

Diagnosis of a Hiatal Hernia

Once a hiatal hernia is suspected, the physician will do one or more tests to confirm the diagnosis. The diagnostic tests which may be performed are usually one or more of the following:

  • Barium X-ray
  • Endoscopy
  • Manometry

Should I Have it Fixed?

There are a number of reasons to fix a hiatal hernia which include persistent reflux despite optimized reflux control medications, desire or inability to continue reflux medications, changes in the tissues above the stomach as seen by biopsy, or any of the above symptoms affecting daily life.

How Do You Fix Hiatal Hernias?

Hiatal hernias are usually repaired with minimally invasive surgery, either laparoscopic or robotic. Using small incisions and long instruments, any hernia content in the chest is brought back into the abdomen and defect is closed to a more appropriate size. Occasionally, a fundoplication (a wrap of the stomach around itself) is done to prevent reflux. Alternatively, a magnetic bead augmentation (LINX) device can be placed to minimize reflux after the repair. Occasionally, a type of weight loss surgery (gastric bypass) is the best procedure for reflux. A number of factors weigh into the best procedure for the individual patient. A discussion with your surgeon and some studies/procedures are needed to help determine which procedure is best for you.

Risks of a Hiatal Hernia Repair Procedure

Hiatal hernia repair is a very safe type of surgery, but there are risks present in any type of surgery. The following complications rarely arise, but they should be noted:

  • Excessive bleeding
  • Breathing problems
  • Reactions to medications
  • Infection
  • Damage to adjacent organs

Recovery After a Hiatal Hernia Repair Procedure

Patients normally stay in the hospital one night. The postoperative diet is advanced over several weeks depending on the surgery performed with progressively more solid food from soft and liquidy foods. You may shower the next day. The incisions are closed with dissolveable stitches underneath the skin and either skin glue that flakes off in 2-3 weeks OR miniature band aids that fall off in 2 weeks. We recommend not lifting greater than 20 pounds for 4 weeks to help prevent the hernia from coming back. We recommend standard walking and daily activities even the day of surgery as tolerated. Most patients need 3-5 days to feel reasonably functional with varying degrees of ability to work.

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