A hiatal hernia occurs when the upper part of your stomach bulges through the large muscle separating your abdomen and chest (diaphragm). Your diaphragm has a small opening (hiatus) through which your esophagus passes before connecting to your stomach. In a hiatal hernia, the stomach pushes up through that opening and into your chest.
Hiatal hernias can range from small—where a small portion of the upper stomach moves into the chest—to very large—where most of the stomach and other organs are in the chest. Regardless of the size, hiatal hernias are associated with GERD and are repaired as the first part of any anti-reflux operation.

Hiatal Hernias and Obesity

Hiatal hernias are often a cause of gastroesophageal reflux disease (GERD) associated with obesity. Patients with obesity typically have significant intra-abdominal pressure, which can cause the Hiatus to expand over time due to the constant upward pressure on abdominal organs. As such, hiatal hernias are typically identified and repaired as part of a primary bariatric surgery procedure. This may reduce the likelihood of GERD after a gastric sleeve.

Types of Hiatal Hernia

Broadly, there are two types of hiatal hernia. The first is a sliding hiatal hernia, which means that the stomach and abdominal contents temporarily move up into the chest cavity and then reduce back into the abdomen.This is very common and considered a type I hiatal hernia. Paraesophageal hiatal hernias, on the other hand, occur when a larger portion of the stomach travels into the chest cavity. These types of hernias can cause various symptoms such as trouble swallowing, recurrent vomiting, GERD or chest pain after meals. They are categorized as type I-III hernias depending on the size. These hernias frequently need to be repaired depending on the health of the patient.

How The Procedure Works

In a hiatal hernia repair, the surgeon will use sutures to bring these muscles back together. The repair is sometimes reinforced with a biologic mesh material in very large hernias. This repair helps to strengthen the reflux barrier and prevent stomach contents from flowing back into the esophagus. It is very common that a patient having an anti-reflux operation, like Nissen Fundoplication or LINX, will also have a hiatal hernia repair.