Type II hiatal hernias occur when the fundus of the stomach herniates through the esophageal hiatus. They are estimated to make up only 5–10% of all diagnosed hiatal hernias ( 6). Type II-IV hiatal hernias are commonly grouped together and called para-esophageal hernias (PEH) ( Figure 1). When symptomatic, patients will commonly present with symptoms of gastroesophageal reflux disease (GERD) ( 5).įigure 1 Diagram demonstrating hiatal hernia types 1-3. Type I hiatal hernias make up more than 95% of hiatal hernias ( Figure 1) ( 4). These are often colloquially called “sliding hiatal hernias”. A type I hiatal hernia occurs when there is intermittent migration of the GEJ into the mediastinum. Hiatal hernias can be classified by the position of the gastroesophageal junction (GEJ) and the extent of stomach that is herniated. The prevalence of hiatal hernia varies in the literature from 15–20% in western populations ( 1- 3). Theories on the etiology of hiatal hernia range from esophageal shortening due to progressive acid exposure, weakness in the crural diaphragm due to aging, and longstanding increased intra-abdominal pressure from obesity or chronic lifting and straining. Received: 10 January 2020 Accepted: 27 March 2020 Published: 20 July 2020.Ī hiatal hernia refers to herniation of intra-abdominal contents through the esophageal hiatus of the diaphragm. Keywords: Hiatal hernia paraesophageal hernia (PEH) recurrence hiatal hernia repair This review will synthesize the most recent body of knowledge to clarify which hiatal hernias should be repaired and which should be observed. The current body of literature is constantly expanding, with new evidence for and against aggressive repair of these hernias appearing on a monthly basis. Since there is wide variability in the symptomatology and severity of hiatal hernias, it is important to understand when repair of these hernias is indicated. Conversely, they may also be entirely asymptomatic and never progress. If untreated, they may progress to gastric volvulus necessitating emergency surgery and partial or total resection of the stomach with resultant increased morbidity, length of stay, and mortality. These hernias may become symptomatic and lead to gastroesophageal reflux disease (GERD), dysphagia, dyspnea, and may affect cardiac and respiratory function. Abstract: Hiatal hernias are a common occurrence in the western population, with an estimated prevalence of 15% to 20%.