Paraesophageal hernia

Rare form of diaphragmatic hernia. It represents 3.5 to 5 % of all hiatal hernias. There is a congenital and an acquired form.


The congenital form is classified into four types:


I:        or sliding hiatal hernia, where only the cardia is intrathoracic

II:        the oesogastric junction is in a normal anatomical position but the gastric fundus lies in the thorax

III:        the oesogastric junction and the gastric fundus are in the thorax

IV:        organs other than the stomach (colon, spleen, epiploon etc.) are present in the thorax.



These congenital forms are sometimes associated with Marfan syndrome or microgastria. They increase the risk of intragastric volvulus. The symptomatology is highly variable: antenatal diagnosis, accidental discovery, vomiting, breathing difficulties (III, IV), stunted growth and anemia. Surgical treatment involves the resection of the herniated sac and the creation of an anti-reflux mechanism (Nissen or Toupet).

The acquired form is one of the possible complications of any surgery performed near the esophageal hiatus, including fundoplication.


Anesthetic implications:

upper abdominal surgery, epidural analgesia, careful ventilation by mask to avoid gastric insufflation

References : 

Updated: April 2020