A paraesophageal hiatal hernia occurs when the upper portion of the stomach pushes upward through the hiatus, a normal opening in the muscle of the diaphragm alongside the esophagus, while the remaining portion of the stomach and the esophagus remain in place.
Less common than other types of hernias, a paraesophageal hiatal hernia can lead to serious complications such as incarceration and strangulation. If signs of these complications begin to occur, immediate surgery may be required to treat the condition.
Causes of a Paraesophageal Hiatal Hernia
The specific cause of a paraesophageal hiatal hernia is not known. It is suspected that a paraesophageal hiatal hernia may occur as a result of the following:
- An injury in the affected area
- After an excessive bout of coughing
- Pregnancy and delivery
- Weight gain
- Episodes of vomiting
A paraesophageal hiatal hernia occurs most commonly in patients who are over the age of 50, overweight and smokers.
Symptoms of a Paraesophageal Hiatal Hernia
Some patients do not experience symptoms from a paraesophageal hiatal hernia and may not require treatment for this condition. It is important to monitor this condition on a regular basis and seek medical attention at the first signs of an incarceration or strangulation of the hernia.
Patients with a paraesophageal hiatal hernia may experience the following symptoms:
- Severe chest pain
- Middle and upper abdominal pain
- Difficulty swallowing
- Shortness of breath
- Stomach ulcer
- Gastroesophageal reflux disease, or GERD
Diagnosis of a Paraesophageal Hiatal Hernia
A paraesophageal hiatal hernia may be diagnosed with either a specialized X-ray exam called a barium swallow, which allows your doctor to clearly identify abnormalities of the esophagus, or with an upper endoscopy.
Treatment of a Paraesophageal Hiatal Hernia
Most repairs of a paraesophageal hiatal hernia may be performed successfully with laparoscopic surgery. During the procedure, the stomach is repositioned into the abdominal cavity. The hiatus is closed to prevent the stomach from re-herniating. Recovery after a laparoscopic repair of a paraesophageal hiatal hernia includes a short hospital stay and, with the surgeon's approval, a return to normal activities within four weeks.