Editing Hiatal hernia (section)

== '''Types:''' ==

* The key differentiating     factor is the location of GOJ and fundus
* Type I - '''sliding''' (95%)
** Displacement of GOJ above      diaphragm into the posterior mediastinum
** Fundus below diaphragm (no      paraoesophageal hernia)
** Occurs because of laxity of      the phreno-oesophageal membrane
** Associated with trauma,      congenital, iatrogenic
** Often leads to GORD, with      larger hernias conveying a higher risk for pathological GORD
* '''Paraoesophageal''' - true hernia with a sac and     part of the fundus above the diaphragm
** Recognised complication of      surgical dissection of the hiatus
** II - defect in      phreno-oesophageal membrane - fundus is above but GOJ remains anchored in      the abdomen
** III - mixed - elements of I      and II - both GOJ and fundus herniate through hiatus
** IV - large defect in      phreno-oesophageal membrane - includes other organs in hernial sac, e.g.      colon, spleen, pancreas, or small bowel
**