The esophagus or food pipe crosses from the chest into the abdomen through an opening in the breathing muscle called hiatus. A hiatal hernia develops when the hiatal opening enlarges leading to herniation of the stomach into the chest. There are four types of hiatal hernia:
- Type one hiatal hernia is the most common and is also called sliding hiatal hernia. The gastroesophageal junction moves up and down the hiatus.
- Type two hiatal hernia occurs when the gastro-esophageal junction remains attached at the level of the hiatus and the stomach herniates into the chest.
- Type three hiatal hernia is characterized by displacement of the gastric fundus and body into the chest.
- Type four hiatal hernia is like type three hiatal hernia with other organs such as colon and spleen herniating into the chest.
Both type 3 and 4 hiatal hernias are associated with gastric volvulus. Gastric volvulus occurs when the stomach twist on itself in the chest leading to obstruction and decreased gastric blood perfusion. Patients present with acute onset pain and bloating without being able to vomit. This condition is considered is a surgical emergency requiring immediate repair to prevent gastric tissue necrosis, sepsis and possible death.
Hiatal hernias are associated with acid reflux disease. Laparoscopic hiatal hernia repair is an important component of any anti-reflux surgery. Hiatal hernia surgery consists of
- Hernia sac complete dissection and resection
- Distal esophagus mobilization
- Crural muscle approximation with pledgeted sutures
- Occasional use of biologic mesh to reinforce the repair
The minimally invasive procedure performed through tiny incisions allows for fast recovery with minimal post-operative pain and complications. When performed by an experienced surgeon, laparoscopic hiatal hernia repair is safe and effective. It allows the restoration of normal anatomy, thereby eliminating the risk of stomach strangulation, acid reflux, and difficulty swallowing food.
Download a case study presentation on Hiatal Hernia Repair by Dr. Elias Darido
Is hiatal hernia surgery appropriate for you?
At Houston Heartburn and Reflux Center, Dr. Darido offers a thorough and comprehensive evaluation for hiatal hernia and acid reflux patients. Depending on your reflux stage, Dr. Darido will recommend the appropriate treatment that suits you best.