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Massive (Paraesophageal) Hiatal Hernia

Donna E. Maziak, F. Griffith Pearson

Key Points

  • Paraesophageal hiatal hernia is a confusing term, and it is used interchangeably and incorrectly for both type II and type III hiatal hernias.
  • Massive (type III and IV) hiatal hernia is the natural progression of a sliding (type I) hiatal hernia.
  • Life-threatening emergency complications are rare, and the potential for these complications is not an indication for urgent repair.
  • Regardless of the approach, the principles of repair are identical.

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Last updated: July 21, 2026