Hiatus hernia

Hiatus hernia may be asymptomatic or may present with heartburn, dysphagia, odynophagia, hoarseness, asthma, shortness of breath, chest pain, anaemia or haematemesis, or a combination of these.

Common risk factors are obesity and increased age. Other known risk factors include intra-abdominal pressure from various conditions, and a previous hiatus operation.

An upper gastrointestinal fluoroscopy with oral contrast is the key investigation technique and aids the surgeon in characterising any anatomical variation necessary for preoperative evaluation. Computed tomography scanning with 3-dimensional reconstruction can be helpful if the diagnosis is unclear, or when planning surgery.

The necessity for, and type of treatment, depends on the patient's symptoms and the anatomical configuration of the hernia.

Uncomplicated sliding hiatus hernias are treated symptomatically with medical therapy, although some patients may select surgical therapy. Complicated hiatus hernias (those with bleeding, volvulus, or obstruction) have a stronger indication for surgical repair.

Hiatus hernia is the protrusion of intra-abdominal contents into the thoracic cavity through an enlarged oesophageal hiatus of the diaphragm.[1]Society of American Gastrointestinal and Endoscopic Surgeons. Guidelines for the management of hiatal hernia. Apr 2013 [internet publication]. http://www.sages.org/publications/guidelines/guidelines-for-the-management-of-hiatal-hernia ​

Various subtypes exist which are are classified anatomically. A hiatus hernia most commonly contains a variable portion of the stomach (type I, II, or III); less commonly, it may contain the transverse colon, omentum, small bowel, or spleen, or some combination of these organs (type IV).

Sliding type I hiatus hernias are generally differentiated from the remaining three types, which are collectively referred to as para-oesophageal hernias, and the herniated contents are usually contained within a sac of peritoneum.