Upper GI & Hepatobiliary Surgery

Hiatus Hernia

A hiatus hernia is upward displacement of stomach through the oesophageal hiatus; sliding hernia can impair the reflux barrier, while para-oesophageal or mixed hernia can cause early satiety, bleeding, obstruction or volvulus, so treatment is driven by symptoms, complications, anatomy and operative risk.

Definition

A hiatus hernia is displacement of part of the stomach through the diaphragmatic oesophageal hiatus into the chest. Sliding, paraoesophageal and mixed forms have different symptom patterns and risks.

First principles

The anatomical classification predicts the problem

Type 1 (sliding) hernia moves the gastro-oesophageal junction and often the cardia above the diaphragm; it accounts for more than 95% of hiatus hernias. Type 2 (paraoesophageal) hernia places the fundus or another part of the stomach alongside the oesophagus while the junction remains below the diaphragm. Type 3 combines axial and paraoesophageal displacement.

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