Hiatal Hernia
Hiatal hernia refers to a specific hernia that occurs at the esophageal hiatus—the opening where the esophagus passes from the chest into the abdomen, and immediately joins the stomach. Most hiatal hernias consist of a minor degree of protrusion of the stomach into the lower chest cavity. Hiatal hernias can be very large, however, and may contain other intra-abdominal organs such as the colon.
A hiatal hernia does not always cause GERD, nor does every patient with GERD have a hiatal hernia, but hiatal hernia does increase the risk that GERD will be present. Hiatal hernia can be diagnosed by endoscopy or xray. Many large hiatal hernias are discovered by accident on chest xrays or CT scans done for other reasons.
Although small hiatal hernias may present little risk other than to increase the likelihood of GERD, larger ones can allow the herniated organs—stomach or colon—to become twisted or strangulated and require emergency surgery. A very large hernia may push the lungs aside, causing breathing problems. A small hernia can be tolerated if GERD is well controlled, but most “giant” hiatal hernias should be repaired electively. The evaluation is similar to that done for GERD, even if GERD is not present. Fortunately, the surgery is also similar and can be completed laparoscopically in most cases. Our surgeons have a very broad experience with the advanced laparoscopic repair of all varieties of hiatal hernias.
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