Hiatus hernia classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

 Overview

Hiatus hernia may be classified into two types inclding sliding hernia and paraesophageal hernias. Sliding hernia is also called type I hernia and paraesophageal hernia is divided into three subtypes including type II, type III and type IV.

Classification

• Hiatus hernia may be classified into four subtypes:
  • Type I Sliding hernia: 95% of all hiatal hernias are type 1 sliding hernias. Type I sliding hernia characterized by the displacement of the gastroesophageal (GE) junction just above the diaphragm into the thoracic cavity.
  • Type II Paraesophageal hernias: A paraesophageal hernia contains a hernia sac hence is a true hernia. Type II hernias are characterized by upward displacement of the gastric fundus through phrenoesophageal membrane. While the gastroesopheageal junction remains attached to the preaortic fascia and the median arcuate ligament.
  • Type III Paraesophageal hernia: A paraesophageal hernia contains a hernia sac hence is a true hernia. Type 3, is like type 1 and 2, having a part of the stomach that has herniated through the hiatus, but also have an abnormal placement of the gastroesophageal junction in the thoracic cavity.
  • Type IV Paraesophageal hernia: A paraesophageal hernia contains a hernia sac hence is a true hernia. Associated with a large defect in the phrenoesophageal membrane it contains stomach along with other contents of colon, spleen, pancreas, or small intestine etc.

Hiatal hernia

Type I Sliding hernia

Paraesophageal hernias

Type II

Type III

Type IV