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Hiatal Hernias and Paraesophageal Hernias

A "hiatus" means "gap" in Latin. The hiatus is the gap through which the esophagus passes as it traverses the diaphragm going from the chest into the abdomen. The hiatus allows food to pass through on its way to your stomach. A hiatal hernia is a weakening and widening of the hiatus. This allows the stomach to push upward through the diaphragm.

Hiatal Hernias and Paraesophageal hernias are very similar, but hiatal hernias of the sliding variety are the most common type of hernia. Approximately 60% of individuals aged 50 or older have a hiatal hernia. In sliding hiatal hernias, the stomach and the lower esophagus slide up into the chest through the hiatus. Paraesophageal hernias are less common but are more concerning. In these, the esophagus stays in its normal location, but part of the stomach and sometimes other abdominal organs squeeze through the hiatus. Paraesophageal hernias have a higher risk of becoming "strangulated" which is when the blood supply is cut off which is a surgical emergency.

They can be diagnosed through endoscopy or an upper GI series (barium swallow study).

Hiatal hernias can cause a myriad of symptoms. They can present with chest pain, shortness of breath, heart palpitations, vomiting (sometimes bloody) and pain with eating (dysphagia).

Hiatal Hernias can contribute to significant reflux due to the fact that the lower esophageal sphincter is no longer in its proper location in the abdomen. When the lower esophageal sphincter moves into the chest, it no longer functions properly and remains open allowing gastric acid to splash into the esophagus eroding the esophageal lining causing esophagitis. Given that hiatal hernias are associated with gastroesophageal reflux disease (GERD), they are associated with increased heartburn, esophagitis, Barrett’s esophagus, esophageal cancer and dental erosion.

Risk factors for developing a hiatal hernia include heavy lifting, chronic coughing pregnancy, violent or frequent vomiting, straining, constipation, obesity, heredity, smoking, drug use and stress.

Hiatal Hernia and Paraesophageal Hernia Surgery

The surgery for both forms of hernias is the same. Using the latest techniques, our surgeons perform hiatal hernia and paraesophageal repairs entirely laparoscopically. The surgery consists of three important steps.

First, the hernia is "reduced". We meticulously remove the attachments that hold the stomach and esophagus in the chest. After doing this important part of the procedure, the lower esophageal sphincter (LES) is returned to its standard position in the abdomen where it works more effectively.

Second, the hiatal hernia is closed. We close the hiatal hernia with permanent sutures. Depending on the size of the hernia, an absorbable piece of mesh may be used to buttress the repair in order to decrease recurrence rates which are high if the size of the hiatal hernia is large.

Third, a fundoplication is performed. This is when the stomach is wrapped around the lower esophageal sphincter. The fundoplication serves two purposes. It prevents any further reflux and it bulks up the stomach so that it will not try and push through the hiatus again.

Our surgeons are the only surgeons in Brandon, Florida to perform this procedure and are part of only a handful of skilled surgeons that peform this surgery in the Tampa Bay Area.

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