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Hiatal Hernia

Types of partial migration of the stomach through the diaphragmatic hiatus and its laparoscopic treatment.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Hiatal Hernia?

A hiatal hernia is the partial or complete migration of the stomach into the chest through the oesophageal hiatus, the opening in the diaphragm through which the oesophagus passes. Type I (sliding) hernia, in which the gastro-oesophageal junction migrates upward, is the most common (95%). Type II (paraoesophageal): the fundus herniates beside the hiatus while the gastro-oesophageal junction stays in place. Types III–IV are mixed and complex forms.

A sliding hiatal hernia is the most common anatomical cause of gastro-oesophageal reflux disease (GORD). Paraoesophageal hernia is less commonly associated with reflux but carries the risk of gastric volvulus and strangulation.

Endoscopy and barium swallow confirm the diagnosis. Large paraoesophageal hernias require surgical repair; in sliding hernias, surgery is indicated when GORD is refractory to medical treatment or when complications arise.

Symptoms

Substernal burning (heartburn) and regurgitation
Reflux symptoms that worsen lying down or bending forward
Difficulty swallowing (dysphagia) and chest pain
Postprandial fullness and early satiety in paraoesophageal hernia
Occult gastrointestinal bleeding and iron-deficiency anaemia (Cameron lesions)
Shortness of breath and palpitations with large hernias

Risk Factors

Obesity and advanced age
Chronic cough and constipation
Heavy lifting
Pregnancy
Oesophageal motility disorders
Connective-tissue diseases (Marfan, Ehlers–Danlos)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Chronic reflux symptoms refractory to medical therapy (PPI)
  • Difficulty swallowing and chest pain
  • Unexplained iron-deficiency anaemia
  • Sudden pain during meals in paraoesophageal hernia (gastric obstruction)
  • Shortness of breath together with postprandial discomfort

Treatment Methods

01
Proton-pump inhibitor (PPI): medical treatment of GORD associated with sliding hernia
02
Laparoscopic Nissen fundoplication with hiatal repair: the gold standard for GORD surgery
03
Paraoesophageal hernia: elective laparoscopic repair in symptomatic or large hernias
04
Hiatal mesh repair: biological or synthetic mesh added to suture repair in large defects
05
Gastric reduction and crural sutures: returning the stomach into the abdomen and repairing the diaphragm
06
Strangulated paraoesophageal hernia: emergency surgery

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.