A hernia develops when an organ pushes through an abnormal opening in the tissue or muscle that surrounds it. A paraesophageal hernia is a rare type of hernia that typically develops in adults.

To understand what a paraesophageal hernia is, it is important to understand the anatomy of the region between the esophagus and the stomach. Between the esophagus and the stomach is the diaphragm. The esophagus passes through an opening, called the hiatus, in the diaphragm, and down into the abdominal cavity to attach to the stomach. A paraesophageal hernia  develops when the stomach pushes up through this opening and into the chest cavity.

Paraesophageal hiatal hernia repair is a minimally invasive surgical technique used to treat paraesophageal hiatal hernias and relieve symptoms. Thoracic surgeons at MedStar Washington Hospital Center are specialists in the diagnosis and surgical treatment of paraesophageal hiatal hernias. They are specialty trained and skilled in the use of cutting-edge, minimally invasive techniques for hernia repair.

Why Paraesophageal Hiatal Hernia Repair Is Performed

Paraesophageal hiatal hernia repair is performed to eliminate the symptoms caused by a paraesophageal hernia. In many patients, a paraesophageal hernia may not cause any symptoms. When paraesophageal hernias do cause symptoms, they often include:

  • Difficulty swallowing
  • Pain in the upper abdomen
  • Pain in the chest
  • Stomach ulcer
  • Shortness of breath

When symptoms are present due to a paraesophageal hernia, patients are at a higher risk of developing the following conditions:

  • Incarcerated hernia: An incarcerated paraesophageal hiatal hernia occurs when the stomach gets stuck in the hiatal opening.
  • Ischemia: Ischemia occurs when blood supply to the stomach is reduced due to it becoming incarcerated, limiting the amount of oxygen and nutrients that reach the organ.

What to Expect During a Paraesophageal Hiatal Hernia Repair Procedure

For paraesophageal hiatal hernia repair, patients are placed under general anesthesia. A few, small incisions in the abdomen, measuring approximately a quarter of an inch long, are made. In one incision, a small camera is inserted into the abdominal cavity. This camera allows the surgeon to see while performing the surgery. Through the remaining incisions, special instruments, called laparoscopic instruments, are inserted.

During the surgery, the surgeon works to carefully replace the stomach to its natural position, pulling it back through the hiatus and into the abdominal cavity. Then, the hiatal opening of the diaphragm is closed to prevent the hernia from recurring.

Risks Associated with Paraesophageal Hiatal Hernia Repair

Paraesophageal hiatal hernia repair is performed using minimally invasive techniques. Minimally invasive surgeries generally come with fewer risks compared to open surgical techniques. However, any surgery does have some risk of complication. Risks associated with paraesophageal hiatal hernia repair include:

  • Infection
  • Bleeding
  • Abdominal bloating
  • Difficulty swallowing
  • Difficulty burping
  • Damage to one or more of the internal organs
  • Pneumothorax (A collapsed lung caused by the presence of air between the lungs and the chest wall)

Benefits of Paraesophageal Hiatal Hernia Repair

Minimally invasive surgeries offer many benefits to patients compared to open surgical techniques, including:

  • Smaller incisions
  • Shorter operating room times
  • Significantly less recovery time
  • Lower infection rates
  • Shorter hospital stays and faster recovery times

How to Prepare for Paraesophageal Hiatal Hernia Repair

Pre-procedure requirements will be thoroughly explained to the patient by the surgeon and associated caregivers. Some of these instructions may include:

  • Do not eat or drink after midnight the night before the surgery
  • Do not take any medications that can thin the blood, such as ibuprofen, for a certain number of days before surgery

It is important to follow these instructions to ensure a safe surgery.

Post Paraesophageal Hiatal Hernia Repair Treatment

Following surgery, patients may be required to remain in the hospital for monitoring for one to two days. Patients may also be required to follow a special diet after returning home that firstly includes an all liquid diet, then slowly works up to a soft food diet, and finally, to normal eating. It’s important to follow the post-procedure protocol provided by the surgeon as well as attend all follow-up appointments to prevent possible complications from occurring. Most individuals can return to their normal activities in two to three weeks after surgery.


Make an Appointment

For an appointment with a specialist, call 202-877-3627.