Hiatal Hernia Surgery

Abstract

Hiatal hernia is a protrusion of abdominal organs through enlarged esophageal hiatus. Hiatal hernia is a relatively common pathology but, in most cases, it remains asymptomatic. Four types of hiatal hernia exist. Type I or sliding hernia, type II or true paraesophageal hernia, type III or mixed hernia and type IV or giant hernia. Diagnosis of hiatal hernia usually is done by upper endoscopy and upper GI barium study. Treatment of hiatal hernia type I coincide with concomitant gastroesophageal reflux treatment, while treatment of hiatal hernia type II, III and IV is mainly surgical. The surgical approach to repair hiatal hernia could be either transabdominal or transthoracic. Currently, laparoscopy is the best method for hiatal hernia repair. Surgery consists of two main steps: hiatal hernia plasty and fundoplication. Despite modern technologies recurrence rate in large hiatal hernia repair remains high, therefore reinforcement of diaphragm by mesh is recommended. Controversies exist about used materials and techniques.