Hiatal hernia

Hiatal hernia is defined by an abnormal ascent of digestive organs in the thorax through the esophageal hiatus . Hiatal hernias are classified as sliding hernias or para-esophageal hernias. Sliding hernias (95% of the cases) are characterized by the ascent of the upper part of the stomach, the junction between the esophagus and the stomach, into the thorax. Para-esophageal hernias (5% of the cases) result from the ascent of the stomach to the level of the thorax, associated or not with an ascent of the junction between the esophagus and the stomach.

Hiatal hernias are often asymptomatic

Hiatal hernias are usually asymptomatic, but can manifest as stomach discomfort and pain behind the sternum due to acid reflux (gastroesophageal reflux disease ).

Therefore, hiatal hernias are usually incidentally discovered, during examinations performed for other reasons, or when searching for the cause of gastroesophageal reflux disease.

Rare complication of hiatal hernia

In rare cases, hiatal hernias may be complicated by incarceration of abdominal organs into the chest. This complication requires urgent surgical management.

Diagnostic management of hiatal hernias

The assessment of hiatal hernias includes gastroscopy, abdominal CT scan and/or X-ray with ingestion of radiological contrast product, esophageal pH monitoring , and sometimes esophageal manometry .

Sliding hiatal hernias are treated with medication

Sliding hiatal hernias do not usually require surgical treatment. In the event of symptoms of gastroesophageal reflux disease , they are treated with drugs decreasing the stomach acidity.

Surgical treatment of para-esophageal hiatal hernias

Surgical treatment is reserved for para-esophageal hiatal hernias in young people with symptoms. The intervention is performed under general anesthesia and by laparoscopy with robotic assistance. The surgical procedure involves removing the hernia sac and closing the hole around the esophagus in order to prevent recurrence. As a next step, a fundoplication is performed. The fundoplication is either partial (the stomach is wrapped around the esophagus at 270 0 , intervention of Toupet), or complete (the stomach is wrapper around the esophagus at 360⁰ , intervention of Nissen). Sometimes, this intervention must be performed by laparotomy .