Hiatal Hernia (Paraesophageal Hernia)

People with a paraesophageal or hiatal hernia can experience a range of uncomfortable symptoms that are similar to gastroesophageal reflux disease (GERD). These symptoms may include:

• Heartburn
• Chronic cough
• Feeling stomach acid flow up into your esophagus
• Getting full quickly or having pain after eating
• Shortness of breath
• Chest pain
• Trouble swallowing
• Anemia (low red blood cells) without a known cause

In many cases, people may have some of these symptoms for years before they are diagnosed with a hiatal hernia or paraesophageal hernia, which can be treated.

People may notice more frequent or severe heartburn, chest pain, coughing or other symptoms as their hernia gets worse.

Symptoms like sharp chest pain, vomiting, fever and bloody stools could be signs that the stomach has “twisted” and cut off its blood supply, which can happen if some hernias are not treated. This is considered a medical emergency that requires surgery.

In many people with paraesophageal or hiatal hernias, the diaphragm becomes weaker as they get older. Eventually, a “hole” develops in the muscle wall that becomes bigger over time, creating an opening for the stomach to move up into the chest.

Older people are most at risk for hiatal and paraesophageal hernias because the diaphragm becomes weaker with age. Other factors that may contribute to these hernias are obesity, previous pregnancy, and physical strain or trauma.

Typically, people who develop the more serious paraesophageal hernias are older women, although men may also have them. Researchers haven’t identified the reason why women are more affected than men by paraesophageal hernias.

If you have symptoms such as heartburn or feeling full soon after eating, your doctor may recommend various tests to determine if you have a hernia. These may include:

• Chest X-ray, which involves swallowing a liquid called barium so doctors can check your esophagus and stomach
• Upper endoscopy, in which a tube with a tiny camera is inserted down your throat to check your esophagus and stomach
• Esophageal manometry, which measures how well the muscles in your esophagus work

Paraesophageal and hiatal hernias tend to get worse over time, making them more difficult to treat. That is why we recommend early diagnosis and treatment whenever possible.

Many times, people with these hernias don’t even realize how much their symptoms are affecting their daily lives until they have surgery to ease their discomfort.

If you have a paraesophageal or hiatal hernia, surgery may help you regain control of your life again. It may also help you avoid having emergency surgery down the road if your stomach “twists” and cuts off your blood supply to your stomach, which can happen in people with paraesophageal hernias. That is why doctors typically recommend surgery to treat a hernia before it becomes an emergency.

At UChicago Medicine, surgeons use minimally invasive procedures and robotic surgery to repair hiatal and paraesophageal hernias. After surgery, most people can go home the same day or the following day. Most patients find relief from their symptoms within a few weeks.

Your surgeon will work with you to determine if you are a good candidate for surgery. In general, you may be a candidate if:

• A large portion of your stomach has moved into your chest
• You have frequent symptoms like heartburn and chronic cough
• You are healthy enough for surgery

Our expert surgical team performs a high volume of surgeries to treat hiatal hernias as well as serious paraesophageal hernias. Our team was also the first in the world to advance a new technique to treat paraesophageal hernias called a posterior rectus sheath flap hiatal augmentation (PoRSHA). PoRSHA eliminates the need for the use of mesh.

A new surgery for patients with paraesophageal and hiatal hernias

Traditional paraesophageal repairs typically use artificial or biological mesh to close the hole in the diaphragm. During a posterior rectus sheath flap hiatal augmentation (PoRSHA), the surgeon uses the patient’s own muscle to repair the diaphragm, so a mesh implant is not necessary. Specifically, the surgeon takes part of the muscle attached to the liver and creates a “flap” that helps support the diaphragm. The surgery is completely "meshless" — no synthetic or artificial materials are used. We perform it using robotic and minimally invasive surgery techniques for a quicker recovery.

You may be a candidate for this novel approach if you have a large paraesophageal hernia or a recurrent hiatal hernia.