Hiatal Hernia

A hiatal hernia is a medical condition characterized by the abnormal protrusion of the upper part of the stomach or other internal organs through the diaphragm's hiatus. The diaphragm is a muscular structure that assists in respiration. The diaphragm has a small opening, a hiatus, through which the esophagus passes before connecting to the stomach. The region where the esophagus joins the stomach is called the "gastroesophageal junction" (GEJ). In a hiatal hernia, the stomach pushes through the diaphragmatic opening into the chest, compromising the lower esophageal sphincter (LES). This laxity of the LES may allow gastric contents and acid to back up into the esophagus, leading to gastroesophageal reflux disease (GERD). Small hiatal hernias are often asymptomatic and typically managed medically. Large hiatal hernias usually require surgery (see  Massive Hiatal Hernia). Hiatal hernias can cause symptoms such as heartburn, regurgitation, and difficulty swallowing. The condition is more common in adults than children and rarely results in life-threatening complications. However, severe hiatal hernias are typically repaired surgically through various procedures, often in conjunction with laparoscopic Nissen fundoplication. Hiatal hernias are classified into 4 types: Type I: The sliding type, representing more than 95% of hiatal hernias. This type occurs when the GEJ is displaced toward the hiatus. Type II: A paraesophageal hiatal hernia, which occurs when part of the stomach migrates into the mediastinum parallel to the esophagus. Type III: A paraesophageal hernia combined with a sliding hernia, where both the GEJ and a portion of the stomach have migrated into the mediastinum. Type IV: The stomach and an additional organ, such as the colon, small intestine, or spleen, herniate into the chest. Proper classification of this condition guides short- and long-term treatment.