Any time an internal body part pushes into an area where it doesn’t belong, it’s called a hernia. The hiatus is an opening in the diaphragm – the muscular wall separating the chest cavity from the abdomen. Normally, the esophagus goes through the hiatus and attaches to the stomach. In a hiatal hernia, the stomach bulges up into the chest through that opening. Para-esophageal hernias are less common large hiatal hernias. When they start to cause symptoms (chest pain, upper abdominal pain, difficulty swallowing), it is a cause for concern and these should be repaired. Symptomatic paraesophageal hernias are at higher risk for progressing to incarceration (stomach gets stuck resulting in obstruction) or ischemia (blood supply to the stomach is cut off) resulting in the need for emergency surgery.
The use of advanced laparoscopic techniques in the management of patients with large type II, type III, and type IV paraesophaeal hernias has completely changed the treatment of this condition. Typically patients with these types of hernia are older and have multiple medical conditions. In the past, many patients were not referred for surgery because of concerns that they would not survive this type of surgery which was performed through large chest incisions. Patients would be in the hospital for weeks with high rates of complications.
Paraesophageal hernias are now repaired using an abdominal approach with advanced laparoscopic techniques. Patients experience minimal pain with the surgery and are usually home in 1-2 days – even older patients. More importantly, the use of new types of mesh to reinforce the hiatal hernia repairs has markedly decreased the recurrence rates. Patients now can expect to have a big operation through small incisions that leaves them with an excellent quality of life.