A hiatal hernia is a hernia through the diaphragm and consists of an enlargement of the natural opening that allows the esophagus to pass from the chest to the abdomen and into the stomach.

There are three types. Type I, is known as a sliding hernia where the stomach slides through the hernia up into the chest. Type II is called paraesophageal hernia. This means the body of the stomach pushes up into the chest along-side the esophagus. This puts the patient at risk for stomach twisting, obstruction or even ischemia. The symptoms include severe chest pain, nausea and vomiting undigested food when the stomach gets up in the hernia sac. A Type III hiatal hernia is a combination of the two.

Type I hernias are strongly associated with gastroesophageal reflux disease (GERD), but can usually be treated with acid reducing medication. However, the surgical treatment is laparoscopic Nissen fundoplication, which is a laparoscopic operation where the surgeon wraps the floppy upper stomach around the esophagus to prevent the acid reflux. In addition, the hiatal hernia is repaired with sutures and usually mesh.

This operation has about 85% success rate for symptomatic GERD and these results are similar to long term omeprazole, but may be more cost effective in the long run. Lap Nissen is very effective in relieving respiratory symptoms in selected patients with GERD. However, a hiatal hernia repair in conjunction with a roux-en-Y gastric bypass is the treatment of choice for morbidly obese patients with refractory GERD.

We thoroughly work patients up with endoscopy, barium swallow, Ph testing, manometry and sometimes gastric emptying studies, to find the subset of patients who best benefit from anti-reflux surgery.

National surgical panels have stated that laparoscopic repair of paraesophageal hernias should be undertaken when they are diagnosed to prevent the complications of obstruction and gastric volvulus. This has been our practice as well. It has been shown in multicenter trials that hiatal repair with biologic mesh significantly reduces the recurrence rate. We have been using this mesh since 2006 with excellent results.

When patients present, we outline a complete diagnostic workup in conjunction with our gastroenterology colleagues. For standard cases, we do laparoscopic repair of the hiatal hernia after complete dissection and we suture the mesh in place. We usually add a fundoplication as most surgeons do in the United States.

Patients are usually in the hospital for one or two nights and remain on a liquid diet for two weeks.

For an evaluation of your hernia, and recommendations for treatment, please call to schedule an appointment with one of our surgeons, 847-433-1060.