ABSTRACT
In 1853, Henry Bowditch was the first to describe paraesophageal hernias. The relationship of the gastroesophageal junction to the herniated fundus of the stomach, and presence of other herniated abdominal viscera, classifies hiatal hernias into four types. Etiology of paraesophageal hernias remains unknown, likely a combination of acquired and genetic factors. Familial clustering suggests a possible autosomal dominant mode. The central acquired factor is chronically increased intra-abdominal pressure that results in disruption of the phrenoesophageal membrane with enlargement of the hiatus and ultimate herniation. Small hernias, due to loss of barrier function of the lower esophageal sphincter, present most commonly with reflux-related symptoms, including heartburn and regurgitation. The most controversial issue regarding the operative management of paraesophageal hernias relates to mesh reinforcement of the crural repair. Despite best efforts, a sizeable proportion of hernias will recur. Radiologic recurrence must be distinguished from clinical recurrence.
