Hiatus Hernias

Overview

  • This refers to herniation of the stomach through the diaphragm
  • The diaphragm opening should be at the level of the lower oesophageal sphincter and should be fixed in place
  • The opening helps to maintain a narrow sphincter that stops acid and stomach contents refluxing into the oesophagus
  • When there is herniation and broadening of the diaphragm opening, this allows contents to reflux up into the oesophagus and give reflux symptoms
  • Treatment is either conservative (with medical treatment of reflux) or surgical repair if high risk of complication or causing severe symptoms

 

Types

  • Sliding (AKA Type 1 Hiatus Hernia)
    • The stomach slides up along with the oesophagus through the diaphragm
  • Rolling (AKA Type 2 Hiatus Hernia)
    • A separate portion of the stomach (i.e. the fundus), folds around and enters through the diaphragm opening along with the oesophagus
  • Type 3 Hiatus Hernia
    • A combination of a sliding and rolling hiatus hernia
  • Type 4 Hiatus Hernia
    • A large hernia allows other intraabdominal organs to pass through the diaphragm opening (e.g. bowel, pancreas, omentum)
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