More than half of the population has a hiatal or paraesophageal hernia. However, most people are symptom free. Hiatal hernias and paraesophageal hernias may cause symptoms such as reflux and heartburn; nausea, burping, and vomiting; regurgitation of food; unexplained upper abdominal or chest pain; a sense of fullness after eating; bloating; shortness of breath or coughing; or a sense of food getting stuck in the chest. Severe symptoms occur when the bowel or stomach twists or loses its blood supply. These include heart racing, palpitations, shortness of breath, chest pain, severe vomiting, lack of bowel movements, and severe abdominal pain. These symptoms require immediate medical attention.

In general, all paraesophageal hernias causing symptoms should be repaired. Common symptoms from a paraesophageal hernia include:

Almost all paraesophageal hernias can successfully and safely be repaired laparoscopically (with about 5 very small incisions) and through the abdomen (rather than the chest cavity). The laparoscopic repair of large paraesophageal hernias (most of the stomach resides above the diaphragm in the chest cavity) is a complex procedure and should only be attempted by expert laparoscopic surgeons with extensive experience in laparoscopic foregut surgery. During surgery, the stomach is gradually moved back into the abdominal cavity. The diaphragm at the esophageal hiatus is closed to prevent the stomach from re-herniating. In some cases, a special kind of mesh is needed to close the diaphragm appropriately. Once the diaphragm has been closed, most patients undergo a fundoplication or a ‘wrap’ similar to what is done for a patient with GERD. The fundoplication is performed to help keep the stomach from herniating back into the chest cavity.