Welcome back to SurgiSmart - Cut to the Core podcast, where we break down essential surgical topics to help you understand surgical conditions. I’m your host, Major Munish Chauhan, and I am a General Surgery Registrar in the British Army and Oxford Deanery. I am also a Senior Research Fellow at the Centre for Army Leadership, where I research, write, and deliver presentations on leadership domains such as self-leadership, resilience, metacognition, cultural diversity, and psychological safety.

Today, we’ll be discussing Hiatal Hernias—a common condition in general surgery that presents with a range of symptoms and has specific management guidelines. Let’s cut to the core of this topic.”

Hiatal Hernias, focusing on their anatomy, physiology, pathology, diagnosis, and management based on the latest NICE guidelines. So, what exactly is a hiatal hernia? A hiatal hernia occurs when part of the stomach protrudes through the diaphragm into the chest cavity, disrupting the normal anatomy and function of the upper gastrointestinal tract. This can lead to a range of symptoms, from acid reflux to chest pain, and sometimes even more serious complications if left untreated.

There are two main types of hiatal hernias that are important to differentiate: sliding and paraoesophageal hernias.

• Sliding hiatal hernias are the most common type. In these, the gastro-oesophageal junction and part of the stomach slide upwards through the diaphragm. This is often associated with gastroesophageal reflux disease (GERD), leading to symptoms like heartburn, regurgitation, and chest discomfort.

• Paraoesophageal hiatal hernias, on the other hand, are less common but more dangerous. In this type, part of the stomach bulges through the diaphragm beside the oesophagus, potentially causing severe complications like gastric volvulus or strangulation, which can compromise the blood supply to the stomach and become life-threatening.