THE multiplicity of terms that have been used to describe herniation of the stomach alongside the esophagus and into the posterior mediastinum suggest the confusion which exists concerning both the pathophysiology and the management of this disorder. Up-side-down stomach, rolling hernia, intrathoracic stomach, parahiatal, and paraesophageal hernia are only a few of the terms applied to this problem. With few exceptions, this condition has not been separated in the literature from sliding hernia, and yet the sequelae and management of the two conditions are entirely different.
In textbooks published as recently as 1958,1 illustrations of what are called parahiatal hernia show a component of the diaphragm between the herniated stomach and the esophagus, with a separate opening adjacent to the esophageal hiatus through which the stomach reportedly herniates. A substantial segment of the diaphragm lying between the herniated stomach pouch and esophagus is described, but the anatomical details of