Paraoesophageal hernia simply refers to a giant hiatus hernia. This equates to more than 5cm or 1/3 of the stomach protruding through the oesophageal hiatus and up into the chest. Occasionally, there will be some of the colon, pancreas or omentum (fat sheet) also up in the chest.
Giant hiatus hernia is simply a severe form of hiatus hernia. The underlying causes and surgical treatment options are very similar. The surgery, whilst always keyhole, takes a bit longer and can involve a longer stay in hospital.
In comparison to reflux and heartburn symptoms usually seen with smaller hiatus hernias, patients with giant hiatus hernias often develop obstructive symptoms. These means reflux symptoms are, as the hernia becomes very large, replaced by problems with nausea, vomiting and chest pains with eating. This is caused by the stomach becoming abnormally mobile in the chest hernia cavity, allowing it to fold on itself and become obstructed. Some patients may even get shortness of breath, due to impaired heart function caused by the abnormal stomach in the chest compressing the heart so that it can’t fill properly.
Upper endoscopy will demonstrate the size of the hernia. Barium (dye) swallow and CT scan are often required to better define the problem and allow more detailed surgical planning.
Diagnosis of paraoesophageal hernia is often made from detailed history taking. Upper endoscopy, barium swallow and/or CT scan help to separate a simple hiatus hernia from a giant/paraoesophageal hernia.