Upper Gastrointestinal Surgery Unit

HIATAL HERNIA

Hiatal hernia is a hernia of the stomach through the diaphragm. It may be present in patients suffering from gastro-esophageal reflux disease or presents itself as an isolated anatomic abnormality without excessive gastro-esophageal reflux.

In the latter situation, a large hernia that compresses and irritates the heart or the lungs so as to provoke cardiac dysrythmia or dyspnea requires an operation to replace the herniated portion of the stomach in the abdomen, to reduce the size of the diaphragmatic hiatus and to reconstruct an anatomically-normal gastro-esophageal junction. An antireflux procedure such as a partial or a complete fundoplication may be added in the presence of pathologic reflux of gastric contents into the esophagus. Anchorage of the stomach on to the posterior aspect of the anterior abdominal wall helps maintain the stomach in the abdomen.

Acute incarceration of the stomach in the diaphragmatic hiatus has to be operated on in an emergency because this situation exposes the patient to the risk of gastric necrosis in the chest.

Asymptomatic hernias in elderly people do not require any operation unless they become symptomatic.