Hiatal Hernia

What is a Hiatal Hernia?

A hiatal hernia occurs when a portion of the stomach moves up into the chest cavity. The diaphragm separates the chest cavity from the abdominal cavity. A natural hole in the diaphragm allows the esophagus to pass from the chest to the abdomen. When the ligaments holding the esophagus in position becomes loose, the hole becomes too large. This allows the stomach to partially rise up through the hole into the chest cavity.

What Are the Symptoms of Hiatal Hernia?

• Increased GERD symptoms, especially when lying down
• Heartburn
• Regurgitation of food or liquids into the mouth
• Difficulty swallowing
• Chest or abdominal pain
• Shortness of breath
• Vomiting of blood or passing of black stools, which may indicate gastrointestinal bleeding

How Is Hiatal Hernia Diagnosed?

First, a physician performs an endoscopy procedure to examine the esophagus for erosive esophagitis and other conditions before evaluating the GEV and measuring the hiatal hernia if present.

To spot any anatomic abnormalities such as a hiatal hernia, blockages, inflammation of the esophagus, and free reflux, the physician may also perform an upper GI series. Typically lasting 30 minutes, this procedure involves the patient ingesting a solution that the physician monitors via x-ray. The procedure may rule out esophageal disorders such as achalasia, which can cause reflux-like symptoms.

How Can a Surgeon Repair a Hiatal Hernia?

• Minimally invasive Laparoscopic Techniques - Under general anesthesia, a surgeon accesses the underside of the diaphragm using minimally invasive laparoscopic techniques. Depending on the anatomy and size of defect, the surgeon repairs the ligaments with stitches and/or mesh. Your surgeon does not open, remove, or reroute anything during the procedure.
• TIF Procedure – Transoral Incisionless Fundoplication (TIF) uses suction to “reduce” small sliding hiatal hernias of 2 cm or less. The suction helps the physician move the GEV below the diaphragm while it’s being repaired. If your hiatal hernia is larger than 2 cm, your physician performs a TIF procedure with an endoscope after repairing the sliding hiatal hernia laparoscopically. Learn more about TIF

Combined Procedure Benefits (TIF and Laparoscopic):

• Only put under general anesthesia once
• Length of stay in the facility usually doesn’t change
• Usually return home the same day as the procedure
• Recovery time for combined procedure is the same as having the TIF procedure on its own; minor incisions heal normally. 

This content was last medically reviewed in May 2022 by Sharlotte Manley, MSN, FNP, Erlanger Gastroenterology.