When an internal body part pushes into an area where it doesn't belong, it's called a hernia. The hiatus is an opening in the diaphragm - the muscular wall separating the chest cavity from the abdomen. Normally, the esophagus goes through the hiatus and attaches to the stomach. In a hiatal hernia, the stomach bulges up into the chest through that opening. There are two main types of hiatal hernias: sliding and paraesophageal (next to the esophagus).
In a sliding hiatal hernia, the stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. This is the more common type of hernia. These sliding hiatal hernias are a risk factor for gastroesophageal reflux disease (GERD), and many patients with hiatal hernias suffer from GERD symptoms such as heartburn.
The paraesophageal hernia is less common, but is more cause for concern. In many patients, paraesophageal hernias may not cause any symptoms for the patient. These asymptomatic hernias can be safely observed and do not require surgery. When a paraesophageal hernia begins to cause symptoms (chest pain, upper abdominal pain, difficulty swallowing), these are usually repaired.
Most paraesophageal hernias can be safely repaired laparoscopically (with about 5 very small incisions) and through the abdomen (rather than the chest cavity). This minimally invasive procedure may be aided by the da Vinci robot.
During surgery, the stomach is gradually moved back into the abdominal cavity. The diaphragm at the esophageal hiatus is closed to prevent the stomach from re-herniating. In some cases, a special kind of mesh is needed to close the diaphragm appropriately. Once the diaphragm has been closed, most patients undergo a fundoplication or a ‘wrap’ similar to what is done for a patient with GERD. The fundoplication is performed to help keep the stomach from herniating back into the chest cavity.
In the hands of Meridian’s Esophageal surgeons, the results of laparoscopic paraesophageal hernia repair are excellent. A minimally invasive laparoscopic approach results in significantly fewer complications than an open abdominal approach. Most patients are in the hospital for only 1-2 days, and are back to their usual activities within 4 weeks.