Hiatus hernias

Question 1

What are the two types of hiatus hernia?

Answer 1

Sliding hiatus hernia (80%) - the gastro-oesophageal junction slides up into the chest. Acid reflux happens as the lower oesophageal sphincter becomes less competent in many cases.

Rolling hiatus hernia (20%) - the gastro-oesophageal junction remains in the abdomen but a bulge of stomach herniates up into the chest alongside the oesophagus. as the gastro-oesophageal junction remains intact, gross acid reflux is uncommon.

Question 2

How are hiatus hernias treated?

Answer 2

Lose weight

Treat reflux symptoms

Surgery indications: intractable symptoms despite aggressive medical therapy, complications .

It is advised to repair rolling hiatus hernia prophylactically (even if asymptomatic) as it may strangulate and then require prompt surgical repair.