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Hiatal Hernia

Hernias are protrusions of internal organs through an opening in the abdomen. A hiatal hernia is a protrusion of the stomach or other organs through the esophageal hiatus, an opening in the diaphragm that allows the esophagus to pass from the chest to the abdomen.

A hiatal hernia is more likely to present when GERD is diagnosed, but it is not usually the sole cause, and many GERD patients do not have a hiatal hernia. When present, a hiatal hernia makes the lower esophageal sphincter (LES) move into the chest. In the chest the LES works poorly and can be more likely to allow reflux. In years past, many doctors referred to GERD as a "hiatal hernia", but the two are really distinct separate problems. A hiatal hernia is best seen with a barium xray, is also usually easy to see at an endoscopy exam. Larger hernias may be found accidentally on a chest x-ray or CT scan.

A hiatal hernia that is small will not affect treatment, and even the largest ones are typically taken care of during any laparoscopic surgery for GERD. Large hiatal hernias may limit patients from having procedures such as TIF (transoral incisionless fundoplication) but safe laparoscopic surgical repair is almost always an option.

Some hiatal hernias are so large that they threaten the stomach with twisting and strangulation. These are repaired regardless of whether the patient has GERD, although other symptoms are almost always present with a hernia this large. Special techniques for reinforcing the repaired diaphragm make the repair stronger and recurrence of the hernia less likely.

Large hiatal hernias are increasingly common with our aging population and better testing. Fortunately, we have extensive success with laparoscopic repair of even the largest hiatal hernias.