A paraesophageal hernia is a type of hiatal hernia located between the gastroesophageal junction and the diaphragm.
With a paraesophageal hernia, the gastroesophageal junction remains in its proper place and a fold of the stomach slips into the chest, pressed between the gastroesophageal junction and the diaphragm.
A less common type of hiatal hernia, it is more cause for concern because of its location. This is because, when symptoms do occur, paraesophageal hernias are at greater risk for either incarceration – obstruction of the stomach – or ischemia, cutting off blood supply to the stomach, resulting in the need for emergency surgery.
However, many paraesophageal hernias show no symptoms. Symptoms may include GERD (gastric reflux), chest pain, upper abdominal pain and difficulty swallowing.
A variety of tests are needed to diagnose the problem. A chest X-ray will be followed by an upper GI exam and possibly a CT scan. An upper endoscopy should be performed to assess the lining of the esophagus and stomach. Esophageal manometry, which measures the contractions of the esophagus, may also be needed.
If the paraesophageal hernia has no symptoms, it can be monitored by your healthcare provider and no surgery is required. If you have GERD, you will be treated with appropriate medications. Surgery is only necessary if GERD continues. Surgery may also be needed if you have chest and upper abdominal pain and difficulty swallowing due to increased risk for stomach obstructions/loss of blood supply. The procedure is generally performed laparoscopically, which is less invasive than open abdominal surgery.
A laparoscopic hiatal hernia repair involves specialized video equipment and instruments that allow a surgeon to repair the hiatal hernia through several tiny incisions, most of which are less than a half-centimeter in size. The concept of the repair remains the same as the open approach. The organs that have herniated into the chest are reduced back into the abdomen, the diaphragm is repaired using either sutures of a piece of mesh, and part of the stomach is wrapped partially or completely around the esophagus to prevent further reflux symptoms. The advantages of this method include a shorter hospitalization, less pain, fewer and smaller scars and a shorter recovery.