Coexisting Achalasia and Large Hiatal Hernia

The occurrence of hiatal hernia and achalasia in the same patient is considered to be extremely rare. Although hiatal hernia is reported with a 40-50% frequency in the general population, its occurrence and potential implications in achalasia are less well known. Disorders of the oesophagus present a diagnostic and therapeutic challenge. The presenting symptoms of dysphagia, reflux, pain and vomiting are almost universal, irrespective of the underlying pathology. A combination of endoscopy, barium studies, pH studies and manometry are often required to determine the exact diagnosis and to plan the most effective treatment. In this video, we introduce our patient with type II achalasia who had a large hiatal hernia. After releasing the hernia sac and performing myotomy, a hiatoplasty and Dor fundoplication was done.