Skip to main content
SpringerLink
Log in

Hiatal Hernia

  • Chapter
  • First Online:
Benign Esophageal Disease

Abstract

Hiatal hernia is a common finding in the general population. Due to the progressing aging of the population and the epidemic of obesity, its prevalence will probably increase in the future. Hiatal hernia can be divided into four groups. Although many patients are asymptomatic, complaints related to gastroesophageal reflux disease (GERD) are typical for type I. Types II, III, and IV may present with dysphagia and respiratory/cardiac impairment caused by direct compression, as well as anemia secondary to bleeding. Acute symptoms are more common for types II, III, and IV. Volvulus, strangulation, obstruction, ischemia, necrosis, and perforation are potentially lethal complications. Asymptomatic hiatal hernia does not require surgery, and the majority of patients with type I hiatal hernia who have symptoms may be successfully treated with PPIs. Preoperative evaluation should involve endoscopy, barium swallow, esophageal manometry, ambulatory pH monitoring, and in some cases computed tomography. Hiatal hernia repair with fundoplication is the recommended surgical approach.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Davis SS Jr. Current controversies in paraesophageal hernia repair. Surg Clin North Am. 2008;88(5):959–78.

    Article  Google Scholar 

  2. Gordon C, Kang JY, Neild PJ, et al. The role of the hiatus hernia in gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2004;20:719–32.

    Article  CAS  Google Scholar 

  3. Wilson LJ, Ma W, Hirschowitz BI. Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol. 1999;94(10):2840–4.

    Article  CAS  Google Scholar 

  4. Pandolfino JE, El-Serag HB, Zhang Q, Shah N, Ghosh SK, Kahrilas PJ. Obesity: a challenge to esophagogastric junction integrity. Gastroenterology. 2006;130(3):639–49.

    Article  Google Scholar 

  5. Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc. 2001;15(9):986–9.

    Article  CAS  Google Scholar 

  6. Kahrilas PJ, Kim HC, Pandolfino JE. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol. 2008;22(4):601–16.

    Article  Google Scholar 

  7. Curci JA, Melman LM, Thompson RW, Soper NJ, Matthews BD. Elastic fiber depletion in the supporting ligaments of the gastroesophageal junction: a structural basis for the development of hiatal hernia. J Am Coll Surg. 2008;207(2):191–6.

    Article  Google Scholar 

  8. Schlottmann F, Andolfi C, Herbella FA, Rebecchi F, Allaix ME, Patti MG. GERD: presence and size of hiatal hernia influence clinical presentation, esophageal function, reflux profile, and degree of mucosal injury. Am Surg. 2018;84(6):978–82.

    Article  Google Scholar 

  9. Khanna A, Finch G. Paraesophageal herniation: a review. Surgeon. 2011;9(2):104–11.

    Article  Google Scholar 

  10. El Khoury R, Ramirez M, Hungness ES, Soper NJ, Patti MG. Symptom relief after laparoscopic Paraesophageal hernia repair without mesh. J Gastrointest Surg. 2015;19(11):1938–42.

    Article  Google Scholar 

  11. Roman S, Kahrilas PJ. The diagnosis and management of hiatus hernia. BMJ. 2014;349:g6154.

    Article  Google Scholar 

  12. Stylopoulos N, Gazelle GS, Rattner DW. Paraesophageal hernias: operations or observation? Ann Surg. 2002;236(4):492–500; discussion 500–1

    Article  Google Scholar 

  13. Peters JH. SAGES guidelines for the management of hiatal hernia. Surg Endosc. 2013;27(12):4407–8.

    Article  Google Scholar 

  14. Stylopoulos N, Rattner DW. The history of hiatal hernia surgery: from Bowditch to laparoscopy. Ann Surg. 2005;241(1):185–93.

    Article  Google Scholar 

  15. Schlottmann F, Strassle PD, Farrell TM, Patti MG. Minimally invasive surgery should be the standard of care for paraesophageal hernia repair. J Gastrointest Surg. 2017;21(5):778–84.

    Article  Google Scholar 

  16. Luketich JD, Nason KS, Christie NA, et al. Outcomes after a decade of laparoscopic giant paraesophageal hernia repair. J Thorac Cardiovasc Surg. 2010;139:395–404.

    Article  Google Scholar 

  17. Hashemi M, Peters JH, DeMeester TR, et al. Laparoscopic repair of large type III hiatal hernia: objective follow-up reveals high recurrence rate. J Am Coll Surg. 2000;190:553–61.

    Article  CAS  Google Scholar 

  18. Mattar SG, Bowers SP, Galloway KD, et al. Long-term outcome of laparoscopic repair of paraesophageal hernia. Surg Endosc. 2002;16:745–9.

    Article  CAS  Google Scholar 

  19. Pierre AF, Luketich JD, Fernando HC, et al. Results of laparoscopic repair of giant paraesophageal hernias: 200 consecutive patients. Ann Thor Surg. 2002;74:1909–15.

    Article  Google Scholar 

  20. Smith GS, Isaacson JR, Draganic BD, et al. Symptomatic and radiological follow-up after para-esophageal hernia repair. Dis Esophagus. 2004;17:279–84.

    Article  CAS  Google Scholar 

  21. Zaninotto G, Portale G, Costantini M, et al. Objective followup after laparoscopic repair of large type III hiatal hernia. Assessment of safety and durability. World J Surg. 2007;31:2177–83.

    Article  Google Scholar 

  22. Dallemagne B, Kohnen L, Perretta S, Weerts J, Markiewicz S, Jehaes C. Laparoscopic repair of paraesophageal hernia. Long-term follow-up reveals good clinical outcome despite high radiological recurrence rate. Ann Surg. 2011;253(2):291–6.

    Article  Google Scholar 

  23. Aly A, Munt J, Jamieson GG, et al. Laparoscopic repair of large hiatal hernias. Br J Surg. 2005;92:648–53.

    Article  CAS  Google Scholar 

  24. Oelschlager BK, Pellegrini CA, Hunter J, et al. Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair. A multicenter, prospective, randomized trial. Ann Surg. 2006;244:481–90.

    PubMed  PubMed Central  Google Scholar 

  25. Frantzides CT, Madam AK, Carlson MA, et al. A prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg. 2002;137:649–52.

    Article  Google Scholar 

  26. Johnson JM, Carbonell AM, Carmody BJ, et al. Laparoscopic mesh hiatoplasty for paraesophageal hernias and fundoplications. A critical analysis of the available literature. Surg Endosc. 2006;20:362–6.

    Article  CAS  Google Scholar 

  27. Carlson MA, Condon RE, Ludwig KA, et al. Management of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatus hernia repair. J Am Coll Surg. 1998;187:227–30.

    Article  CAS  Google Scholar 

  28. Tatum RP, Shalhub S, Oelschlager BK, et al. Complications of PTFE mesh at the diaphragmatic hiatus. J Gastrointest Surg. 2007;12:953–7.

    Article  Google Scholar 

  29. Lee YK, James E, Bochkarev V, et al. Long-term outcome of cruroplasty reinforcement with human acellular dermal matrix in large paraesophageal hiatal hernia. J Gastrointest Surg. 2008;12:811–5.

    Article  Google Scholar 

  30. Tatum RP, Shalhub S, Oelschlager BK, Pellegrini CA. Complications of PTFE mesh at the diaphragmatic hiatus. J Gastrointest Surg. 2008;12(5):953–7.

    Article  Google Scholar 

  31. Stadlhuber RJ, Sherif AE, Mittal SK, Fitzgibbons RJ Jr, Michael Brunt L, Hunter JG, Demeester TR, Swanstrom LL, Daniel Smith C, Filipi CJ. Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc. 2009;23(6):1219–26.

    Article  Google Scholar 

  32. Parker M, Bowers SP, Bray JM, Harris AS, Belli EV, Pfluke JM, Preissler S, Asbun HJ, Smith CD. Hiatal mesh is associated with major resection at revisional operation. Surg Endosc. 2010;24(12):3095–101.

    Article  Google Scholar 

  33. Oelschlager BK, Pellegrini CA, Hunter JG, Brunt ML, Soper NJ, Sheppard BC, Polissar NL, Neradilek MB, Mitsumori LM, Rohrmann CA, Swanstrom LL. Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair:long-term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg. 2011;213(4):461–8.

    Article  Google Scholar 

  34. Patterson EJ, Herron DM, Hansen PD, Ramzi N, Standage BA, Swanström LL. Effect of an esophageal bougie on the incidence of dysphagia following Nissen fundoplication: a prospective, blinded, randomized clinical trial. Arch Surg. 2000;135(9):1055–61.

    Article  CAS  Google Scholar 

  35. Horgan S, Pohl D, Bogetti D, et al. Failed antireflux surgery: what have we learned from reoperations? Arch Surg. 1999;134:809–15.

    Article  CAS  Google Scholar 

  36. Hunter JG, Smith CD, Branum GD, et al. Laparoscopic fundoplication failures: patterns of failure and response to fundoplication revision. Ann Surg. 1999;230:595–604.

    Article  CAS  Google Scholar 

  37. van Beek DB, Auyang ED, Soper NJ. A comprehensive review of laparoscopic redo fundoplication. Surg Endosc. 2011;25:706–12.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Surgery and Medicine, University of North Carolina, Chapel Hill, NC, USA

    Kamil Nurczyk & Marco G. Patti

  2. Department of Surgery, University of North Carolina, Chapel Hill, NC, USA

    Marco Di Corpo

Authors
  1. Kamil Nurczyk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Di Corpo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marco G. Patti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco G. Patti .

Editor information

Editors and Affiliations

  1. Jackson North Medical Center, University at Buffalo, Miami, FL, USA

    Natan Zundel

  2. Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    W. Scott Melvin

  3. Department of Surgery and Medicine, University of North Carolina, Chapel Hill, NC, USA

    Marco G. Patti

  4. Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Diego Camacho

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Nurczyk, K., Di Corpo, M., Patti, M.G. (2021). Hiatal Hernia. In: Zundel, N., Melvin, W.S., Patti, M.G., Camacho, D. (eds) Benign Esophageal Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-51489-1_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-51489-1_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-51488-4

  • Online ISBN: 978-3-030-51489-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation