A sheet of muscle, the diaphragm separates the chest from the abdominal cavity. The oesophagus passes through a hole in the diaphragm, the oesophageal hiatus. A hiatus hernia is an enlargement of this hole allowing the upper portion of the stomach to slide up and down through the oesophageal hiatus - a sliding hiatus hernia (85%) of all hiatus hernias. If the hiatus enlarges considerably the stomach may "capsize" and roll upside down into the chest cavity - a rolling hiatus hernia (15% of all hiatus hernias).

Symptoms

Many patients with hiatus hernia have no symptoms at all: the majority of those patients with a sliding hiatus hernia may have symptoms of heartburn and regurgitation - called reflux disease.

A rolling hiatus hernia occurs in more elderly patients and may present with feeling full rapidly after eating, anaemia due to occult blood loss, shortness of breath on exercise or an unpleasant feeling within the lower chest and upper abdomen.

Treatment

Many patients with GORD and hiatus hernias can be managed by adjustments to lifestyle and proton pump inhibitor medical therapy. Large sliding and rolling hiatus hernias may require keyhole surgery.

Landmark paper

Leeder PC, Smith G, Dehn TCB. Laparoscopic management of large paraoesophageal hiatal hernia. Surgical Endoscopy 2003: 17: 1372- 1375.
A study over an eight year period of 53 patients undergoing keyhole surgery for giant rolling hiatus hernia, 4 patients were converted to open surgery and 1 elderly patient died. 5 (9%) patients had a symptomatic recurrence. This paper illustrates that keyhole surgery for giant hiatus hernias is feasible, safe and effective.

Outcome of surgery >>