Repair of Paraesophageal Hiatal Hernia

Paraesophageal hernias are relatively rare, involving less than 1 percent of all hiatal hernias. These hernias occur when the stomach rotates up through the diaphragm to lie within the chest beside the esophagus. Over time these hernias can reach massive proportions.

Paraesophageal hernias may produce a wide variety of symptoms, including heartburn and regurgitation, difficulties with swallowing food, bloating and pain after meals, and bleeding from the stomach resulting in chronic anemia. They can also affect a patient's respiratory status, causing shortness of breath during normal activities.

Because these hernias evolve over a long period of time and may not cause problems until the patient is older, symptoms are often attributed to aging, rather than to the underlying paraesophageal hernia. Many physicians are unaware of the clinical and quality-of-life impact these hernias can have on patients. In addition, the distinction between standard hiatal hernias and paraesophageal hernias is not well understood by most patients or their doctors.

Virginia Mason is a high-volume esophageal surgical center that does between 20 to 30 repairs of paraesophageal hernias each year. To minimize incisions and reduce recovery time, minimally invasive or laparoscopic surgery can be performed for this condition. A recent review of results published in the Annals of Thoracic Surgery in 2002 showed that surgical repair of these hernias significantly improved symptoms of heartburn, dysphagia, regurgitation and anemia, in addition to measurably improving respiratory function. As a result, patients are able to resume normal activities that had been previously abandoned due to shortness of breath. In addition, several patients who required oxygen constantly were able to discontinue this treatment after surgery.

More recently, an article in the Annals of Thoracic Surgery in 2005 reviewed a large population of patients treated at Virginia Mason for symptomatic paraesophageal hernias. The evidence summarized in the article demonstrates that this operation can be done with a high degree of safety, even in the elderly patient population. Symptoms routinely improve following surgical repair. Most importantly, patients demonstrate a measurably higher level of quality of life when compared to the general age-matched population. See the Relevant Publications section for references.