Hiatal hernias may be classified into one of four types. Type I (sliding hiatal hernia) in which there is a migration of the esophago-gastric junction above the diaphragm into the thorax is the most common. Type II is a true paraesophageal hernia in which the stomach herniates into the thorax, but the esophago-gastric junction remains fixed in its normal anatomic location below the diaphragm. Type III (mixed paraesophageal hernia) is a combination of a sliding hiatal hernia with some or all of the stomach herniating above the esophago-gastric junction. Type IV are those hiatal hernias which include abdominal viscera and/or solid organs within the hernia sac. Rarely, a parahiatal hernia, where gastric herniation occurs through a diaphragmatic defect separate from the hiatus, may be seen.
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