Esophageal Hiatal Hernia Repairs

Question 1

Define type I and type II hiatal hernias.

Answer 1

Type I = sliding

Type II = paraesophageal

Question 2

What is a sliding esophageal hiatal hernia?

Answer 2

Both the stomach and the GE junction herniate into the thorax via the esophageal hiatus

Question 3

What is the incidence of sliding hiatal hernias?

Answer 3

> 90% of al hiatal hernias

Question 4

Symptoms of sliding hiatal hernias?

Answer 4

Asymptomatic (most patients)

Reflux, dysphagia (from inflammatory edema), esophagitis, pulmonary problems secondary to aspiration

Question 5

How is a sliding hiatal hernia diagnosed?

Answer 5

UGI series
Manometry
EGD with biopsy for esophagitis

Question 6

What is the treatment of sliding hiatal hernias?

Answer 6

85% of cases are treated medically with antacids, H2 blockers/PPIs, head elevation after meals, small meals, and non food prior to sleeping

15% require surgery for persistent symptoms despite adequate medical treatment

Question 7

What is the surgical treatment for sliding hiatal hernias?

Answer 7

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

Question 8

What is a paraesophageal hiatal hernia?

Answer 8

Herniation of all or part of the stomach through the esophageal hiatus into the thorax without displacement of the GEJ

Question 9

Complications of a paraesophageal hiatal hernia?

Answer 9

Hemorrhage, incarceration, obstruction, strangulation

Question 10

Treatment of paraesophageal hiatal hernia?

Answer 10

Surgical because of the frequency and severity of potential complications