Hernias occur when there is a weakening in muscles. When this involves the diaphragm, the stomach and other abdominal contents can pop up into the chest, creating what is called a paraesophageal hernia. Usually these slide in and out of the chest but sometimes they can get stuck up in the chest – this is called incarceration. Occasionally, the stomach or other viscus can twist, thus strangulating the blood supply to this entrapped viscera and becoming a surgical emergency. Symptoms can include early satiety (feeling full quickly after eating), heartburn, nausea, vomiting, pain, shortness of breath, and bleeding.
To prevent a paraesophageal hernia from getting worse and possibly leading to gangrene, surgery is performed to strengthen the diaphragm and secure the stomach in the abdomen, preventing it from migrating back up into the chest. At Mount Sinai, we use a minimally invasive surgery called laparoscopic paraesophageal hernia (PEH) repair. This operation is accomplished by making five small incisions in the abdomen. With the use of a camera, we reduce the hernia, tighten the diaphragm muscles, wrap the top of the stomach around the lower part of the esophagus, and secure it to the undersurface of the diaphragm. For complex cases, particularly failed repairs or recurrent hernias, oftentimes the best approach is to have a thoracic surgeon operate through the chest. Patients are usually discharged home the next day. The small incisions are barely visible within several weeks of the operation.