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Paraesophageal Hiatal Hernia

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Updated June 15, 2011

A hiatal hernia occurs when the upper part of the stomach pushes through an opening in the diaphragm, and up into the chest. There are two categories of hiatal hernias, sliding or paraesophageal. With paraesophageal hernias, the gastro-esophageal junction remains where it belongs, but part of the stomach is squeezed up into the chest beside the esophagus. These hernias remain in the chest at all times. With this type of hernia, complications can occur.

Complications of a Paraesophageal Hiatal Hernia

  • Incarceration
    This is when the hernia is stuck and being squeezed.
  • Strangulation
    This results from the lack of blood supply, leading to death of the tissues involved.

The Symptoms of a Paraesophageal Hiatal Hernia

Paraesophageal hernias often do not display any symptoms, but when symptoms are present, they are as follows:
  • Sudden severe chest pain
  • Radiating chest pain that isn't relieved by taking an antacid
  • Difficulty swallowing
  • Stomach pain
  • Indigestion
  • Nausea
  • Vomiting
  • Retching

When Surgery is Needed for a Paraesophageal Hiatal Hernia

  • If the above symptoms are caused by a paraesophageal hiatal hernia that has become constricted or strangulated, then immediate surgical intervention is required.
  • If the hiatal hernia is in danger of becoming constricted or strangulated, surgery is often performed to reduce the hernia, putting it back where it belongs.

What Type of Surgery is Done for a Paraesophageal Hiatal Hernia

Hiatal hernia surgery is commonly done as a laparoscopic procedure. The laparoscope is a thin, telescope-like instrument with a camera on the end that enables the surgeon to view the inside of the abdomen. With this type of surgery, small incisions are made in the abdomen. The laparoscope and surgical instruments are inserted through these incisions. During the surgery, the stomach is repositioned and the hiatus is reinforced.

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