A hiatal hernia occurs when the normal opening in the diaphragm is too large. If left untreated, the stomach or other abdominal contents may bulge, or herniate, into the chest. This can cause heartburn, pulmonary aspiration due to the displacement of a lung by the hernia, or GERD (gastroesophageal reflux). There are two types of hiatal hernias — sliding and para-espohageal hernias. In a sliding hiatal hernia, part of the stomach moves up through an opening (hiatus) in the diaphragm. This is the most common type of hernia. A para-esophageal hernia occurs when the stomach twists upon itself and moves into the chest along the esophagus. Patients may have difficulty swallowing or have reflux symptoms.
Sliding hiatal hernias may not require treatment unless symptoms become problematic. Treatments generally include making changes to lifestyle and eating habits, and if necessary, taking antacids, acid reducers or acid blockers. A hiatal hernia may lead to GERD, in which case it will be treated with prescription medication, and if necessary, surgery.
Para-esophageal hernias require a surgical procedure involving moving the herniated area of the stomach back into the abdominal cavity. In an open hiatal hernia repair a cut is made in the stomach area while the patient is under general anesthesia. The esophageal hiatus (the opening in the diaphragm through which the esophagus passes from the chest into the abdomen) is tightened, making it smaller so the stomach can no longer bulge through. The esophagus is then attached to the diaphragm.
In some cases, this procedure can be performed laparoscopically, using a thin, hollow tube with a camera on the end. Surgical tools are sent through the laparoscope to repair the hernia. This procedure results in fewer and smaller incisions, less pain and scarring, and a shorter hospital stay.