Type 1 Hiatal Hernia - Retrograde View

Surgical teaching video: type I hiatal hernia, also called a sliding hiatal hernia, is the most common, constituting 90% of all hiatal hernias. A type I hernia is present when the gastro-esophageal junction migrates cephalad into the posterior mediastinum. This occurs because of laxity of the phrenoesophageal membrane, a continuation of the endoabdominal peritoneum that reflects onto the esophagus at the hiatus. Although these hernias do slide back and forth through the hiatus, they are called sliding hernias because the stomach is part of the wall of the hernial sac. Thus, they are analogous with sliding inguinal hernias, which typically involve partially retroperitoneal organs. The presence of a type I sliding hiatal hernia alone does not constitute an indication for operative repair. In fact, many patients with small type I hiatal hernias do not have symptoms and do not require treatment. During flexible endoscopy, the gastro-esophageal junction is seen at the roof of the herniated stomach. Sliding hernias can grow to become quite large and may result in medically refractory reflux symptoms, warranting surgical intervention.