Hiatal Hernias

Hiatal Hernias (Sliding and Para-esophageal)

A hiatal hernia occurs when part of the stomach protrudes through the diaphragm and up into the chest region. Approximately 15 percent of the population in the United States has a hiatal hernia. Sometimes hiatal hernias are diagnosed in infants, but most are diagnosed in adults and are suspected to have developed over time. 

There are two types of hiatal hernias: sliding and para-esophageal. 

Sliding hiatal hernias 
Sliding hiatal hernias, the most common type, occur when the area where the esophagus and the stomach join (gastro-esophageal junction) and a portion of the stomach protrude into the chest. In some cases, this area permanently protrudes into the chest and in other cases it happens only during swallowing. 

Para-esophageal hiatal hernias 
In the case of a para-esophageal hernia, the gastro-esophageal junction remains in its normal location, but part of the stomach protrudes into the chest next to the esophagus. The para-esophageal hernia always remains in the chest and is not affected by swallowing. 

If a para-esophageal hiatal hernia is large enough, it may press against the esophagus and hinder food from freely passing down the esophagus and into the stomach. Sometimes, ulcers form from the irritation caused by the food that gets stuck in the esophagus. 

At Yale Bariatric/Gastrointestinal Surgery, our innovative surgeons perform minimally invasive procedures, many of which are at the leading edge of gastrointestinal surgery, in order to treat hiatal hernias. Our multidisciplinary team works collectively to create personalized treatment plans that provide the best options for each patient, reflecting his or her specific condition and individual needs.

Causes of Hiatal Hernias (Sliding and Para-esophageal)

Normally, the esophagus passes down through the chest, crosses the diaphragm, and enters the abdomen through a natural opening in the diaphragm, which is called the esophageal hiatus. The esophagus then joins the stomach just below the diaphragm. When a hiatal hernia is present, the esophageal hiatus is larger than normal. This larger opening allows a portion of the upper stomach to slip into the opening and into the chest. 

Other possible causes of a hiatal hernia include a shortening of the esophagus and a loose attachment of the esophagus to the diaphragm.


There are generally no symptoms with a hiatal hernia unless they are very large. When symptoms do occur they tend to be associated with GERD because the hernia interferes with the barrier between the stomach and the esophagus, allowing stomach acid and food to come up into the esophagus.

Symptoms include:

  • Heartburn
  • Regurgitation
  • Nausea

Make An Appointment

Yale Bariatric/Gastrointestinal Surgery Program
40 Temple Street, Suite 7B
New Haven, CT 06510

T 203.785.6060 or 203.785.2616
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