Hiatus Hernia

Key points

Rare in children

Herniation through oesophageal hiatus

Types

Primary: Congenital

Secondary: After fundoplication due to hiatal dissection, then wrap migration into thorax

Type 1: ‘Sliding’ GOJ herniates into thorax

Type 2: ‘Rolling’ Fundus herniates into thorax, GOJ remains in abdomen

Type 3: Both GOJ and fundus herniate

Type 4: Other organs herniate in addition to stomach

Presentation

Reflux

Chest pain

Iron deficiency anaemia

Investigations

CXR first - radiolucency in mediastinum

Upper GI contrast

CT if UGI contrast equivocal

FBC + iron studies

Albumin for nutritional status if severe reflux

Management

Laparoscopic fundoplication

Excise hernia sac

Close crura with sutures

360-degree wrap

If recurrence, may be necessary to use mesh

If type 1 and minimal symptoms, trial of PPI first - but not described in literature

Page edited by Mrs Charnjit Seehra BSc November 2024

References

Garvey EM, Ostlie DJ. Hiatal and paraesophageal hernia repair in pediatric patients. Semin Pediatr Surg. 2017 Apr;26(2):61-66. doi: 10.1053/j.sempedsurg.2017.02.008. Epub 2017 Mar 9. PMID: 28550872.