In this case, a part of the stomach pushes through the hiatus. The hiatus is an opening in the diaphragm, the organ which sits on top of your stomach and regulates breathing. This opening allows the esophagus to pass through the diaphragm and connect to the stomach. When the stomach squeezes through the hiatus, it can become stuck next to the diaphragm. The section of stomach stuck there is at risk for strangulation (loss of blood flow).
These types of hernias are slightly more common in women and can be due to congenital weakness at that spot or increased abdominal pressure. Paraesophageal hernias sometimes are asymptomatic and go unnoticed. But when symptoms resembling bad heartburn persist, it’s important to go to your doctor and get it checked out.
Paraesophageal hernia surgery is frequently performed laparoscopically. A few small incisions are made, through which laparoscopic instruments and a camera are inserted. The surgeon is then able to repair the hernia with very little scarring for the patient.
What’s unique about paraesophageal hernias is that unlike the other types of hernias we treat at Surgical Associates of WNY, these do not usually require mesh. They are repaired by pushing the stomach back through the opening and then suturing it shut using the body’s own tissues.
In some cases, a more involved repair will be used – but it still uses the body’s own tissue. This is known as a Nissen fundoplication. In this procedure, the upper portion of the stomach (which is the fundus) is wrapped around the bottom of the esophagus. This strengthens and tightens the valve between the esophagus and stomach and reduces the likelihood of the hernia recurring. (Note: a Nissen fundoplication is also an effective surgical treatment for extreme gastroesophageal reflux disease, known as GERD. Hiatal hernias are often responsible, at least in part, for reflux.)