What is a hiatus hernia?
The diaphragm is the muscle separating the chest from the abdomen, and the esophagus passes through an opening in it called the hiatus. In a hiatus hernia, part of the stomach slides or pushes up through this opening into the chest, which can weaken the body's natural barrier to acid reflux.
- Sliding hiatus hernia: the gastroesophageal junction and part of the stomach move up into the chest, the more common pattern
- Paraesophageal hiatus hernia: part of the stomach pushes up alongside the esophagus, which can carry a higher risk of complications
Symptoms & when to see a doctor
Many small hiatus hernias cause no symptoms and are found incidentally. Others are associated with heartburn, acid regurgitation, chest discomfort or difficulty swallowing. Sudden severe chest or abdominal pain, or an inability to keep food or liquid down, needs urgent medical attention.
Treatment options
Many hiatus hernias are managed with lifestyle measures and medication to control reflux. Surgery is considered for hernias that cause persistent symptoms despite medical treatment, larger paraesophageal hernias, or when complications develop.
- Laparoscopic hiatus hernia repair: the stomach is repositioned below the diaphragm and the hiatus is narrowed, usually with sutures and sometimes reinforced with mesh
- Fundoplication: wrapping part of the stomach around the lower esophagus, usually combined with the repair to reduce the risk of reflux afterwards
Recovery
Recovery after laparoscopic hiatus hernia repair is generally quicker than after open surgery, with a gradual return to a normal diet as advised by the care team.
Where suitable, this may be carried out using minimally invasive techniques. See Minimally Invasive Surgery.
Frequently asked questions
What is the difference between a hiatus hernia and an abdominal wall hernia?
A hiatus hernia occurs at the diaphragm, where part of the stomach moves into the chest. Abdominal wall hernias, such as inguinal, umbilical and incisional hernias, occur through a weak spot in the muscles of the abdominal wall. The two are unrelated conditions with different repairs.
Does every hiatus hernia need surgery?
No. Many hiatus hernias are managed with medication and lifestyle measures. Surgery is considered when symptoms persist despite treatment, the hernia is large, or complications develop.
What is fundoplication and why is it done with hiatus hernia repair?
Fundoplication wraps part of the stomach around the lower esophagus to strengthen the barrier to acid reflux. It is commonly combined with hiatus hernia repair to reduce the risk of reflux symptoms returning.