Expansion
Sliding hernia moves the junction upwards; rolling hernia keeps it in place
Expansion
- Type I - Sliding (about 95 per cent). The gastro-oesophageal junction slides up through the hiatus into the chest. The angle of His is lost and the intra-abdominal segment disappears, so the anti-reflux mechanism fails, hence reflux symptoms
- Type II - Rolling (paraoesophageal). The junction stays below the diaphragm, but the gastric fundus herniates alongside the oesophagus. Reflux is often absent, but the hernia can obstruct, incarcerate or undergo gastric volvulus
- Type III - mixed sliding and rolling
- Type IV - other organs herniate too, such as colon or spleen
The distinction drives management. Sliding hernias are treated medically unless reflux is refractory. Rolling hernias risk strangulation and are usually repaired, and an acute gastric volvulus produces Borchardt’s triad: severe epigastric pain, retching without vomiting, and inability to pass a nasogastric tube.