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Surgical management of paraesophageal hernia

Michael Rosen, MD
Jeffrey Blatnik, MD
Section Editors
Joseph S Friedberg, MD
Jeffrey Marks, MD
Deputy Editor
Wenliang Chen, MD, PhD


A paraesophageal hernia is an uncommon type of hiatal hernia that mainly affects older adults with a median age of presentation between 65 and 75 years [1-3]. The hernia includes a peritoneal layer that forms a true hernia sac, distinguishing it from the more common sliding hiatal hernia. Surgical management is indicated when medical management fails to control symptoms (eg, gastroesophageal reflux, dysphagia, regurgitation, anemia, dyspnea, epigastric, or abdominal pain) or when there is a complication (eg, bleeding, obstruction, or gastric volvulus) [4-8].

Surgical management of a paraesophageal hernia will be reviewed here. The anatomy, physiology, types, symptoms, and diagnosis of a hiatal hernia are discussed elsewhere. (See "Hiatus hernia".)


There are four types of hiatal hernias, three of which are paraesophageal hernias (figure 1). The four types of hiatal hernias can be distinguished by the hernia contents and the position of the gastroesophageal junction:

Type I or sliding hiatus hernia is characterized by the displacement of the gastroesophageal junction above the diaphragm. The stomach remains in its usual longitudinal alignment, and the fundus remains below the gastroesophageal junction.

Type II or "true" paraesophageal hernia results from a localized defect in the phrenoesophageal membrane where the gastric fundus serves as a lead point of herniation, while the gastroesophageal junction remains fixed to the preaortic fascia and the median arcuate ligament [7,8].


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Literature review current through: Sep 2016. | This topic last updated: Oct 5, 2016.
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