Figure 7 - Sliding versus paraesophageal hiatal hernia.

With sliding or axial hiatal hernia there is thinning and elongation of the phrenoesophageal membrane leading to herniation of the stomach into the posterior mediastinum. As such, there is no potential for incarceration or strangulation. With paraesophageal herniation, visceral elements herniate through a focal weakness in the phrenoesophageal membrane with the potential to lead to the usual array of complications associated with visceral herniation through a constricted aperture. (Source: Modified from Skinner.¹⁵ with permission from American Gastroenterological Association.)