This is a condition in which the opening in the diaphragm that the oesophagus passes through (the oesophageal hiatus) stretches. This allows the stomach or other organs to slip up and into the chest cavity. These hernias can be categorised into four types:

  • Type 1: Sliding type. The hiatus stretches, and the upper part of the stomach slides up along with the junction between the oesophagus and the stomach.
  • Type 2: Rolling type. Also known as “paraoesophageal hernia”. The junction between the oesophagus and the stomach remains where it belongs below the diaphragm, but the very top of the stomach, the fundus, rolls up through the stretched hiatus.
  • Type 3: Mixed type. A combination of types 1 and 2.
  • Type 4: Organs other than the upper stomach have slipped through the stretched hiatus. Examples include, the entire stomach, part of the liver or part of the colon.

95% are Type 1 and can often be managed with medications alone. Large hiatus hernias can cause reflux, cardiac (heart) symptoms and respiratory (lung) symptoms. These larger hernias often require repair and this is done with key-hole (laparoscopic) surgery, usually combined with a Fundoplication (see Gastro-Oesophageal Reflux section).

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