What is a Paraesophageal Hiatal Hernia?

Paraesophageal hiatal hernia is a condition where a part of the stomach protrudes through the hiatus. Considered a complication of a hiatal hernia, a paraesophageal hernia is an asymptomatic condition, meaning it presents no symptoms. Individuals generally exhibit symptoms associated with a secondary condition, such as gastroesophageal reflux disease (GERD). Medical attention should be sought when symptoms increase in frequency and severity. There are potentially life-threatening risks associated with paraesophageal hernias, and corrective surgery is necessary to prevent further damage and complications.

Hiatal hernias generally result from a weakness in the sphincter muscles of the esophagus located just above the opening of the diaphragm at the junction where the esophagus and stomach meet. Individuals who are obese, have had abdominal surgery, or suffer from a condition which places additional strain on the abdominal muscles are generally at a greater risk of developing a hiatal hernia. Individuals of advanced age or women who are pregnant also have an increased risk of developing this condition.

When a paraesophageal hiatal hernia occurs, the stomach and esophagus remain stationary, but the topmost portion of the stomach protrudes through the opening that leads from the diaphragm to the esophagus, known as the hiatus. The stomach's protrusion places it beside the esophagus where it remains, which can lead to the incarceration or strangulation of the herniated stomach tissue. Incarceration occurs when the herniated tissue is trapped within the opening and constricted. The strangulation of the herniated tissue results from a lack of blood flow, which can lead to the death of the trapped tissue, known as necrosis.

As a hiatal hernia grows, an individual may experience symptoms that include heartburn, chest pain, and nausea. GERD is a common condition which occurs in conjunction with a hiatal hernia. Symptoms associated with GERD include regurgitation and difficulty swallowing, which can contribute to establishing a hernia diagnosis. Medical attention should be sought if symptoms become persistent or increase in severity.

A paraesophageal hiatal hernia diagnosis is confirmed through the administration of either an x-ray or an endoscopic exam of the digestive tract. An x-ray usually employs the use of barium, a contrasting agent administered orally, to provide a clearer profile of the esophagus, small intestine, and stomach. An endoscopic exam utilizes a pliable, thin tube, called an endoscope, to check for inflammation of the esophagus and stomach. Generally, herniated stomach tissue is prominently visible in diagnostic imaging of the digestive tract.

When symptoms are caused by a paraesophageal hiatal hernia that has become strangulated or incarcerated, surgery is required. Generally conducted as a laparoscopic procedure, corrective surgery is minimally invasive and involves the employment of a slender, pliable tube, called a laparoscope, outfitted with a tiny camera. Small incisions are made in the abdomen and the laparoscope is positioned inside the abdomen to provide the attending surgeon with a view of the affected area. Surgical instruments, inserted though the incisions, are utilized to return the stomach to its normal anatomical position. The muscles surrounding the hiatus are repaired, and, in some cases, the opening is reduced to prevent paraesophageal hiatal hernia recurrence.

As with any surgical procedure, there are risks associated with laparoscopic hiatal hernia surgery. Risks include infection, damage to the tissues and organs surrounding the herniated area, and excessive bleeding. Though rare, post-operative complications can include paraesophageal hernia recurrence and difficulty swallowing. A patient’s everyday activities, such as driving and lifting, are usually restricted pending the first follow-up visit.