Chapter 35: Hernias- Esophageal; Type 1 (Sliding)

Question 1

What is it?

Answer 1

Both the stomach and GE junction herniate into the thorax via the esophageal hiatus; also known as type I hiatal hernia

Question 2

What is the incidence?

Answer 2

>90% of all hiatal hernias

Question 3

What are the symptoms?

Answer 3

• Most patients are asymptomatic
• but the condition can cause:
  
  • reflux
  • dysphagia (from inflammatory edema)
  • esophagitis
  • pulmonary problems secondary to aspiration

Question 4

How is it diagnosed?

Answer 4

UGI series, manometry, esophagogastroduodenoscopy (EGD) with biopsy for esophagitis

Question 5

What is the treatment?

Answer 5

• 85% of cases treated medically with antacids, H2 blockers/PPIs, head elevation after meals, small meals, and no food prior to sleeping;
• 15% of cases require surgery for persistent symptoms despite adequate medical treatment

Question 6

What is the surgical treatment?

Answer 6

Laparoscopic Nissen fundoplication (LAP NISSEN) involves wrapping the fundus around the LES and suturing it in place