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hiatus hernia (HH)
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Hiatus hernia is the herniation of an abdominal organ into the thoracic cavity, usually the stomach, through a widening of the oesophageal hiatus in the diaphragm.
Two main types are recognised:
- sliding or axial hiatus hernia – 85-95% of hiatus hernias - this is a direct herniation through the oesophageal hiatus
- paraoesophageal or rolling hiatus hernia – 5-15% - the herniation occurs due to the abdominal organ pushing up beside the oesophagus
Depending on the subdivision of para-esophageal hiatal hernias, a more comprehensive classification has been proposed which divides hiatus hernia into four types:
- type I - sliding hiatal hernia
- type II - classic form of para-oesophageal hernia
- type III - mixture of type I and II hiatal hernia
- type IV - herniation of abdominal structures other than the stomach (spleen, colon, pancreas, etc.) (2)
Type II-IV belongs to the para oesophageal hernia group with type III being the most common (more than 90%) and type II the least common (2).
Rarely patients may present with a giant hiatal hernia, defined by a hernia that includes at least 30% of the stomach in the thorax.
- majority are type III hernia with a sliding and paraesophageal component
- a third of giant paraesophageal hernias are associated scoliosis (1,3).
Reference:
- (1) Roman S, Kahrilas PJ. The diagnosis and management of hiatus hernia. BMJ. 2014;349:g6154
- (2) Kohn GP et al. Guidelines for the management of hiatal hernia. Surg Endosc. 2013;27(12):4409-28
- (3) Mitiek MO, Andrade RS. Giant hiatal hernia . Ann Thorac Surg. 2010;89(6):S2168-73.
Last edited 02/2018
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