A paraesophageal hernia is when the stomach protrudes through a hole in the diaphragm, causing severe chest pain, vomiting, and difficulty swallowing. Surgery is required if the hernia becomes incarcerated or strangulated, and laparoscopic surgery is a common method.
A paraesophageal hernia is a type of hiatal hernia. A hernia occurs when a portion of fatty tissue or an organ pushes through the muscle wall that usually contains it. A hiatal hernia is when a piece of the stomach bulges through the thoracic diaphragm and into the chest cavity. This usually involves only part of the stomach, but in some cases, the entire stomach migrates into the chest cavity.
The thoracic diaphragm, more commonly and simply called the diaphragm, is a plate-like muscle that separates the abdominal cavity from the thoracic, or chest cavity, and helps to contract and expand the chest cavity during breathing. During a paraesophageal hernia, the stomach, an integral organ in the process of digestion, protrudes through a hole normally found in the diaphragm. This hole, called the diaphragmatic hiatus, is located at about the height of the tenth vertebra, counting from head to tail, through which the esophagus passes. The esophagus is a muscular, tubular organ that passes food from the pharynx to the stomach.
When a hiatal hernia occurs without a traumatic cause, it can fall into one of two categories: a paraesophageal hernia, also called a rolling-type hiatus hernia, or a sliding hernia. A sliding hernia, the more common of the two types, occurs when the gastrointestinal junction, the sphincter between the esophagus and stomach, and an upper portion of the stomach protrude through the diaphragmatic hiatus. The herniated tissue, which is usually small, can then slide in and out of the chest cavity.
During a paraesophageal hernia, the fundus, or rounded anterior portion of the stomach, pushes through the esophageal hole into the diaphragm while the gastrointestinal junction remains below the diaphragm. This causes the stomach to rotate, or “roll,” counterclockwise and can lodge above the diaphragm, at the side of the esophagus. Often, patients with a paraesophageal hernia do not have acid reflux because the location of the sphincter between the stomach and esophagus remains unchanged. Although many patients are asymptomatic, a paraesophageal hernia can cause severe chest pain that is unresponsive to antacids, stomach pain, vomiting or wheezing, nausea, indigestion, or difficulty swallowing.
A paraesophageal hernia can be a serious health problem if the hernia becomes incarcerated or strangulated. Incarceration occurs when the herniated tissue freezes in a protruding position and is put under pressure. Strangulation occurs when the blood supply to the herniated tissue is cut off, causing the tissue to die. If there is a risk of either of these two complications occurring, the patient will undergo surgery to push the stomach back into position and strengthen the diaphragmatic hiatus. An incarcerated or strangulated paraesophageal hernia requires immediate surgical repair.
Typically, the surgery is performed laparoscopically. During this type of procedure, the surgeon makes small incisions in the abdomen through which surgical instruments are inserted. A laparoscope, a thin tube-like device with a camera on one end, is inserted into one of the incisions so the doctor can see without performing open surgery, allowing for less scarring, bleeding, and a shorter recovery period. The doctor inserts instruments into the other incisions to reposition the stomach below the diaphragm and strengthen the diaphragmatic hiatus.
Protect your devices with Threat Protection by NordVPN
