[The large hiatal hernia should be acknowledged and respected].

A hiatal hernia is a partial or total dislocation of the stomach, sometimes together with other intraabdominal organs, through the diaphragmatic esophageal hiatus into the thoracic cavity. The condition is common and often asymptomatic. Old age and obesity are risk factors for developing hiatal hernia. Small hernias might induce gastroesophageal reflux, which usually is satisfactorily treated pharmacologically. Larger hiatal hernias are more often associated with obstructive symptoms including dysphagia, vomiting or discomfort/pain due to compression of adjacent organs/tissues. In severe cases, large hiatal hernias may become incarcerated with ischemia in herniated tissues and need of acute surgical intervention. The risk of complications in association with operation for large hiatal hernias is high, particularly in acute surgery and in elderly patients with co-morbidities.