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    Diaphragmatic Hernia (Hiatal Hernia)
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    Diaphragmatic Hernia (Hiatal Hernia)

    Last Updated 14 March 2026
    Ingredients

    A diaphragmatic hernia is when organs in the abdominal cavity (usually the stomach) prolapse upward through an opening in the diaphragm muscle that separates the chest cavity and abdominal cavity.

    Under normal conditions, the esophagus reaches the stomach by passing through a narrow hole (hiatus) on the diaphragm; However, the expansion of this hole prepares the ground for the displacement of the organs.

    This condition is an anatomical disorder that can directly affect not only the digestive system but also respiratory and cardiac functions due to its location in the rib cage.

    Diaphragmatic hernia, also known as “gastric hernia” among the people, is one of the main mechanical causes of reflux complaints.

    Today, with advanced laparoscopic and thoracoscopic surgical methods, the herniated organs can be placed in place and the opening in the diaphragm can be permanently repaired.

    What is Diaphragmatic Hernia? How is it formed?

    Diaphragmatic hernia occurs as a result of increased intra-abdominal pressure or age-related weakening of the tissues in the diaphragm muscle.

    When the esophageal hiatus, the natural opening in the diaphragm, expands, the upper part of the stomach starts to slide through this space and into the ribcage.

    This displacement disrupts the valve mechanism (lower esophageal sphincter) that prevents stomach acid from escaping into the esophagus, leading to severe complaints.

    The Relationship Between Diaphragmatic Hernia and Hiatal Hernia

    Although these two terms are often used interchangeably in the medical literature, hiatal hernia is actually the most common type of diaphragmatic hernia.

    While hiatal hernia refers only to the displacement of the stomach, the term diaphragmatic hernia can sometimes include the passage of the intestines or organs such as the spleen into the chest cavity.

    In both cases, the main problem is that the diaphragm cannot fully fulfill its barrier function.

    Congenital and Acquired Diaphragmatic Hernias

    Diaphragmatic hernias are divided into two main categories based on the time of formation.

    • Congenital Hernias: These are serious cases that are noticed in infancy and occur as a result of the diaphragm not closing completely during its development in the womb.
    • Acquired (Acquired) Hernias: Generally, in individuals over the age of 50; It occurs due to reasons that increase intra-abdominal pressure, such as obesity, heavy lifting or chronic coughing.

    What are the Types of Diaphragmatic Hernia?

    Depending on the shape of the hernia and which part of the stomach goes up, the treatment approach changes completely.

    Sliding Type Diaphragmatic Hernia

    It is the most common type, accounting for about 95% of all cases.

    The junction of the stomach and esophagus slides over the diaphragm and is usually displaced as the patient moves.

    This type of hernia primarily manifests itself with severe reflux complaints.

    Paraesophageal (Stomach Side) Hernias

    It is a rarer but more dangerous species.

    While the junction of the stomach and esophagus remains in place, a part of the stomach (fundus) herniates from the side of the esophagus into the chest cavity.

    Surgical intervention is usually inevitable in this type of hernia, as there is a risk of compression and strangulation of the stomach (strangulation).

    Rare Types: Bochdalek and Morgagni Hernias

    These hernias usually arise from openings in the sides or front of the diaphragm.

    Bochdalek’s hernia is more common in the posterior-lateral part of the diaphragm, while Morgagni’s hernia is in the antero-middle part.

    In these cases, sometimes not only the stomach but also the large intestine parts can be observed in the rib cage.

    Diaphragmatic Hernia Symptoms and Effects on the Body

    Symptoms differ depending on the size of the hernia and the effect of stomach acid on the esophagus.

    Severe Reflux, Burning in the Chest and Difficulty Swallowing

    The most classic symptom is bitter water and a burning sensation (pyrosis) radiating from the stomach to the throat.

    Bending over or lying flat, especially after meals, can make this burning sensation unbearable.

    Over time, irritation of the esophagus can cause difficulty swallowing (dysphagia) and a bitter taste with mouth.

    The Relationship Between Chest Pain and Shortness of Breath

    In large hernias, the stomach can take up space within the rib cage, putting pressure on the lungs and heart.

    This condition causes increased shortness of breath after meals and chest pains that can be mistaken for a heart attack.

    Causes and Risk Factors of Diaphragmatic Hernia

    Both genetic predisposition and lifestyle factors play a role in the development of diaphragmatic hernia.

    • Obesity: Excess weight constantly increases intra-abdominal pressure, forcing the opening in the diaphragm.
    • Aging: As age progresses, the elasticity of the diaphragm muscle decreases.
    • Chronic Pressure: Straining due to constant constipation, severe coughing fits or heavy sports.
    • Genetics: Individuals with connective tissue weakness are at a higher risk of hernias.

    Diaphragmatic Hernia Diagnosis and Diagnostic Methods

    The diagnosis is made by tests to see both the anatomical defect and the damage to the esophagus.

    Medicated Gastric X-ray and Endoscopy

    The x-ray (passage radiography), which is taken by giving the patient a barium liquid, clearly shows how much of the stomach goes up.

    Gastroscopy (Endoscopy) is the most reliable method to directly observe irritation in the esophagus (esophagitis) and the internal structure of the hernia.

    Detailed Imaging with Computed Tomography (CT)

    Especially in large and complex hernias, CT of the Thorax and Abdomen is used to assess the condition of other organs (intestine, spleen).

    CT images are vital for the surgeon to draw the preoperative roadmap.

    Diaphragmatic Hernia Treatment Options

    Lifestyle changes may be sufficient for small hernias, while surgery is the only solution for large and risky hernias.

    Medication and Lifestyle Changes

    Acid-suppressing drugs (PPIs) do not destroy the hernia, but they reduce the damage and pain caused by acid to the esophagus.

    Eating little and often, stopping eating 3 hours before bedtime and lying with the head elevated are the main measures that relieve symptoms.

    Surgical Treatment: Laparoscopic and Thoracoscopic Repair

    Today, diaphragmatic hernia surgeries are performed with the closed (laparoscopic) method over 90%.

    The stomach is pulled into the abdominal cavity by entering through small holes opened in the abdomen and the hole in the diaphragm is narrowed with stitches.

    Patch (Graft) Use and Nissen Fundoplication

    In cases where the diaphragm tissue is weak, special patches (mesh) can be used to secure the hole.

    In addition, the upper part of the stomach is wrapped around the esophagus (Nissen Fundoplication) to create a new valve mechanism; This process permanently ends the reflux.

    Treatment Approaches Comparison Table

    FeatureMedication and LifestyleSurgical Repair (Laparoscopy)
    ObjectivesSuppressing symptomsCorrecting anatomical defects
    HospitalizationNot required1 – 2 Days
    Permanent Solution?No, it returns when the drug is stoppedYes, it provides anatomical repair
    Healing ProcessRequires constant attention2 Weeks (Return to normal life)

    Prof. Dr. Levent Alpay: Diaphragmatic hernia should not be taken as just “heartburn”. Especially in paraesophageal hernias, the risk of gastric strangulation can be a vital emergency. If your reflux complaints do not go away despite medications or if you experience shortness of breath after meals, surgical repair of this mechanical problem in the diaphragm will radically change your quality of life. With modern closed surgery, we can leave this problem behind in a very short time.

    Case Experience (Anonymous): Our 62-year-old patient presented with severe reflux that had been going on for years and palpitations that had been added recently. In the examinations, it was determined that more than half of his stomach protruded into the chest cavity and put pressure on the heart. The stomach was pulled into place by laparoscopic method and repaired with a diaphragm patch (mesh). The patient, whose reflux complaints completely stopped the day after the surgery, returned to his normal diet and sports activities on the 10th day.

    If you are experiencing recurrent reflux complaints or a feeling of getting stuck in the esophagus, you can make an appointment with our clinic and seek expert opinion for the evaluation of hernia risk and the appropriate treatment plan for you.

    Frequently Asked Questions

    Is Diaphragmatic Hernia Surgery Necessary?

    In small slip-type hernias, surgery may not be necessary if the complaints are under control with medication; However, surgery is recommended for large hernias and paraesophageal types that carry a risk of strangulation.

    Is Diaphragmatic Hernia Confused with Heart Pain?

    Yes, the chest pain and pressure sensation caused by a hernia can mimic a heart attack. Therefore, in patients with chest pain, heart problems should be excluded first, and then the diaphragm should be examined.

    Does Hernia Recur After Surgery?

    The risk of recurrence is very low in surgeries performed by experienced surgeons, using patch support and adding the Nissen technique.

    Scientific Bibliography

    Medically Reviewed For informational purposes only

    Prof. Dr. Levent Alpay

    Prof. Dr. Levent Alpay

    As a Thoracic Surgeon, he continues his scientific studies and clinical practices on lung cancer surgery, robotic surgery and minimally invasive methods at Medicana Ataköy Hospital.