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four types of hernias occurring at the hiatus
- Type I is a sliding hiatal hernia in which the GE junction migrates through the hiatus into the posterior mediastinum as a result of laxity of the phrenoesophageal ligament. This is the most common type of hiatal hernia (95%).
- Type II is a true paraesophageal hernia, characterized by an upward dislocation of the fundus of the stomach alongside a normally positioned GE junction. This is the least common type of hiatal hernia.
- Type III is a combination of types I and II, characterized by cephalad displacement of both the GE junction and typically a large portion of the fundus and body of the stomach into the chest. Type III hernias probably start as a sliding hernia, and as the hiatus enlarges over time, a progressively greater portion of the fundus and body of the stomach herniate through the defect. When more than 30% of the stomach is herniated in the stomach, the term giant paraesophageal hernia is used. An intrathoracic stomach is used to describe the condition in which all of the stomach is within the chest.
- Type IV are type III hernias in which other viscera such as the colon or spleen are included in the hernia sac. These are quite uncommon and represent only 2% to 5% of all paraesophageal hernias
Types of Hernias Occurring at the Hiatus
| Hernia Type | Location of Gastroesophageal Junction | Hernia Contents | Spontaneous Reducibility |
|---|---|---|---|
| Type I (Sliding) | Intrathoracic | Fundus | Usually reducible |
| Type II (True paraesophageal) | Intraabdominal | Fundus ± body | Often fixed |
| Type III (Mixed) | Intrathoracic | Fundus + body | Fixed |
| Type IV (Type III with other viscera included) | Intrathoracic | Fundus + body + other organ | Fixed |
