Paraesophageal Hernias

Paraesophageal hernias happen in your torso. The insides of your torso are divided into two parts: The chest, the upper part of the torso, contains the heart and lungs. The abdomen, the lower part of the torso, holds your stomach, intestines, and other organs. A layer of muscle, called the diaphragm, separates the chest and abdomen. The esophagus is the tube that carries food from mouth to stomach.

A hernia happens when an internal part of the body pushes into an area where it doesn’t belong. Hernias often stem from weak muscles. When this happens in the upper part of your stomach, we call it a paraesophageal hernia. Doctors do not know what causes a paraesophageal hernia. At Mount Sinai, we have extensive experience diagnosing and treating paraesophageal hernias.

If you have this condition, you may experience these symptoms:

• Bleeding
• Chest pain
• Feeling full quickly after eating (early satiety)
• Heartburn
• Nausea and vomiting
• Pain in the middle of your upper abdomen
• Shortness of breath
• Stomach ulcer

If left untreated, a paraesophageal hernia can lead to gangrene.

We use several tests to diagnose paraesophageal hernias, including:

• Barium esophagography: After you swallow a barium pill, we perform X-rays to show us any abnormalities in your stomach or esophagus.
• Esophageal manometry: Inserting a cannula with a pressure probe on the end into your esophagus allows us to see how effective your esophageal muscles work.
• pH study: We insert a cannula into your esophagus to measure how much acid is present.
• Upper endoscopy: We insert a thin tube (cannula) into your esophagus with a camera on the end of it. This allows us to see the inside of your esophagus and stomach.

Treatments We Offer

Early intervention is the best way to prevent paraesophageal from progressing to gangrene. Surgery can strengthen the diaphragm and secure the stomach in the abdomen, so it doesn’t move up into the chest. At Mount Sinai, we use a minimally invasive surgery called laparoscopic paraesophageal hernia  repair.

We start by making five small incisions in the abdomen. We insert a thin tube (cannula) with a camera on the end into your abdomen to guide the procedure. Then we pull the stomach back down and shore up the hole in the diaphragm to prevent the stomach from moving again. You will probably be able to go home within a day or two after the procedure. We will put you on a liquid diet, then transition to soft foods. You will eventually be able to return to your usual diet. Four weeks later, you should be back to your regular activities. The small incisions will be barely visible several weeks after the operation.

For complex cases, particularly if a repair has failed or a hernia has recurred, we may use open surgery. This involves a longer hospital stay and slower recovery.

Why Mount Sinai

At Mount Sinai, we have highly trained thoracic surgeons who have extensive experience diagnosing and treating paraesophageal hernias. We work as a team with experts throughout the Mount Sinai Health System and the Icahn School of Medicine at Mount Sinai when appropriate. We are here to help.