A paraesophageal hernia is a type of hiatal hernia where a significant portion of the stomach (and possibly other organs) bulges through a natural opening in the diaphragm and into the chest cavity. This type of hernia can lead to a number of symptoms, including obstructive symptoms (food or liquid sticking, pain after eating, nausea, etc) or symptoms of gastroesophageal reflux disease (GERD), such as heartburn, reflux or regurgitation. Often these symptoms can significantly impair quality-of-life. Rarely, they can be life-threatening.
Diagnosis
If you have symptoms of a paraesophageal hernia, you should speak with your doctor. They will listen to your description of your symptoms and perform a physical exam. For those who do not have symptoms, paraesophageal hernia is often found when seeking care for another problem, like on a CT scan.
Some patients will undergo further testing for GERD, such as esophageal manometry or pH testing to determine if you might benefit from a surgical procedure to strengthen the lower esophageal sphincter (LES) to help alleviate your GERD symptoms.
Treatment
Treatment for paraesophageal hernias can vary depending on the individual case. In some cases, medications and lifestyle changes can help manage the symptoms of the hernia. When symptoms significantly impact your quality of life, surgery may be recommended. The thoracic surgeons at Baylor Medicine repair these hernias at a high volume and most often do so through a minimally invasive approach via laparoscopy or robotically, which offers faster recovery and lower complication rates.
The goal of the surgery is to restore the normal anatomy of your organs, so your surgeon will work to bring down the stomach into your abdomen, below the diaphragm. Next, your surgeon will work to make the hole in your diaphragm (also known as the hiatus) small enough to prevent your stomach or abdominal organs from herniating into your chest. This is usually done by stitching your diaphragm to itself, but sometimes requires a small piece of mesh.
Paraesophageal hernia surgery is often combined with other surgeries to address GERD symptoms, such as LINX or Fundoplication. If you and your surgeon have decided this is right for you, your GERD procedure will be done at the same time as your hernia repair.
Recovery from Surgery
Recovery from paraesophageal hernia surgery usually takes four to six weeks, but many patients feel better very quickly after surgery and can even return to work in one to two weeks. You can expect to spend one to two nights in the hospital after your surgery. You will be instructed to follow a liquid or soft foods diet for a few weeks to allow time for swelling to go down and for your stomach to heal. Your surgeon might instruct you to take crushed or liquid medications during your recovery. You should stay active after surgery – walking starts on day one after surgery. You should gradually increase your activity level back to your baseline. Your surgeon might instruct you to limit how much weight you lift, but a general rule during recovery is do not do anything that causes you pain.
If you have any questions or concerns about your recovery, you should speak with your surgeon as soon as possible to prevent complications.