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A hernia is a common medical condition where an internal organ or tissue pushes through a weak spot or hole in the muscle or connective tissue that surrounds it. For instance, the intestines might push through a weakened area in the abdominal wall. A rare type of hernia is the paraesophageal hernia. In this type of hernia, a part of the stomach or other organs moves into the chest cavity through an opening in the diaphragm next to the oesophagus (food pipe).

We got in touch with Dr Sandeep Aggarwal, Chairman - Manipal Institute of Minimal Access, Bariatric, GI and Robotic Surgery, Manipal Hospital Dwarka, New Delhi shares that while it can sometimes be asymptomatic, if left untreated, it may lead to life-threatening complications. “This condition can cause various symptoms such as chest pain, difficulty swallowing, and shortness of breath due to the pressure it puts on the lungs. In more severe cases, it can lead to nausea, vomiting, or even organ strangulation, which can be fatal.”

“This condition occurs when part of the stomach moves up into the chest through the diaphragm’s opening, called the hiatus, where the oesophagus normally passes. This common condition is mainly divided into four types, with Type I (sliding hiatal hernia) being the most prevalent. It often causes symptoms like heartburn or reflux due to the gastroesophageal junction sliding upward,” he said.

• Obesity: Excess weight can increase pressure on the diaphragm, worsening the condition. Maintaining a healthy weight is essential.

• Eat small, frequent meals: Large meals can exacerbate symptoms.

• Avoid lying down after eating: Wait at least 2-3 hours before lying down to allow proper digestion.

• Elevate the head of the bed: This helps prevent acid reflux during sleep.

• Quit smoking: Smoking can weaken the diaphragm and exacerbate symptoms.

• Limit certain foods: Fatty foods, acidic foods (like citrus fruits or juices), caffeine, and alcohol can trigger symptoms.

According to a study published in the National Library of Medicine, around 5 per cent to 15 per cent of hiatal hernias fall under the paraesophageal category, with prevalence increasing in older people, especially those aged 65 and above. Paraesophageal hernias are typically seen in older adults (aged 65-75 years) and are often caused by weakening of the diaphragm muscles and other supporting tissues. However, trauma or an inherent structural abnormality, like a short oesophagus, can also be a cause, as seen in younger patients.

“A 21-year-old male came with difficulty in breathing for five days. Imaging revealed a complex Type IV paraesophageal hernia, where both the stomach and transverse colon had moved into the chest cavity. The likely causes were past trauma from a road accident or a naturally short oesophagus. The patient underwent successful laparoscopic surgery, and floppy Nissen’s fundoplication, which consisted of reducing the herniated organs back into the abdominal cavity, mobilizing the oesophagus to ensure an adequate intra-abdominal length, and repairing the hiatal defect. To prevent movement, they also attached the stomach to the diaphragm muscles called the crura through a procedure called cruroplasty. As a precaution, the stomach was attached not only to the diaphragm but also to the food pipe. He recovered quickly, with no breathing issues, and was discharged just two days after the procedure,” he shared.

Treatment Options

Dr Sandeep shares that treatment for paraesophageal hernias depends on the severity. Small, asymptomatic hernias may not require immediate intervention, but surgery is often recommended for larger or symptomatic cases. Surgical repair, often done through minimally invasive techniques, involves repositioning the herniated organs and repairing the diaphragm.

“Laparoscopic surgery is preferred due to its faster recovery time and less postoperative pain. The surgeon may also strengthen the diaphragm by placing a mesh to reduce the risk of the hernia coming back. After surgery, most people recover well and see significant improvement in their symptoms. In some cases, doctors may also prescribe medications to reduce acid production and prevent reflux during the healing process,” Dr Sandeep said.

Dr Sandeep explains it is important to get regular checkups, particularly for older adults or anyone with persistent reflux issues. Early detection through imaging like X-rays or CT scans is essential to prevent complications such as volvulus (twisting of the stomach), strangulation, or perforation.

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