Hiatal Hernia (Paraesophageal Hernia)

Hiatal hernias, also known as paraesophageal hernias, occur when part of the stomach pushes into the chest through an opening in the muscle wall (known as the diaphragm) that separates the organs in the chest and abdomen.

At the University of Chicago Medicine, our surgeons are experts in repairing these types of hernias. In fact, our UChicago surgeons have developed a new type of surgery for large paraesophageal hernias that doesn’t require the placement of a permanent mesh implant.

What is a hiatal hernia or paraesophageal hernia?

A paraesophageal or hiatal hernia occurs when part of the stomach moves up into the chest through a hole in the muscular wall called the diaphragm.

The most common type is called a sliding hiatal hernia, in which the stomach and part of the esophagus “slide” up into the chest. A less common but more serious type is a paraesophageal hernia, which occurs when a large part of the stomach bulges up through the diaphragm into the chest so it is pushing into your lungs and heart.

How is a paraesophageal or hiatal hernia treated?

Many times, people with these hernias don’t even realize how much their symptoms are affecting their daily lives until they have surgery to ease their discomfort.

If you have a paraesophageal or hiatal hernia, surgery may help you regain control of your life again. It may also help you avoid having emergency surgery down the road if your stomach “twists” and cuts off your blood supply to your stomach, which can happen in people with paraesophageal hernias. That is why doctors typically recommend surgery to treat a hernia before it becomes an emergency.

At UChicago Medicine, surgeons use minimally invasive procedures and robotic surgery to repair hiatal and paraesophageal hernias. After surgery, most people can go home the same day or the following day. Most patients find relief from their symptoms within a few weeks.

Who is a candidate for paraesophageal or hiatal hernia surgery?

Your surgeon will work with you to determine if you are a good candidate for surgery. In general, you may be a candidate if:

• A large portion of your stomach has moved into your chest
• You have frequent symptoms like heartburn and chronic cough
• You are healthy enough for surgery

Why should I choose UChicago Medicine for paraesophageal or hiatal hernia surgery?

Our expert surgical team performs a high volume of surgeries to treat hiatal hernias as well as serious paraesophageal hernias. Our team was also the first in the world to advance a new technique to treat paraesophageal hernias called a posterior rectus sheath flap hiatal augmentation (PoRSHA). PoRSHA eliminates the need for the use of mesh.

What is posterior rectus sheath flap hiatal augmentation (PoRSHA)?

A new surgery for patients with paraesophageal and hiatal hernias

Traditional paraesophageal repairs typically use artificial or biological mesh to close the hole in the diaphragm. During a posterior rectus sheath flap hiatal augmentation (PoRSHA), the surgeon uses the patient’s own muscle to repair the diaphragm, so a mesh implant is not necessary. Specifically, the surgeon takes part of the muscle attached to the liver and creates a “flap” that helps support the diaphragm. The surgery is completely "meshless" — no synthetic or artificial materials are used. We perform it using robotic and minimally invasive surgery techniques for a quicker recovery.

You may be a candidate for this novel approach if you have a large paraesophageal hernia or a recurrent hiatal hernia.