Abstract
Purpose: Hiatal hernias are a common finding on radiographic or endoscopic studies. Hiatal hernias may become symptomatic or, less frequently, can incarcerate or become a volvulus leading to organ ischemia. This review examines latest evidence on the diagnostic workup and management of hiatal hernias. Methods: A literature review of contemporary and latest studies with highest quality of evidence was completed. This information was examined and compiled in review format. Results: Asymptomatic hiatal and paraesophageal hernias become symptomatic and necessitate repair at a rate of 1% per year. Watchful waiting is appropriate for asymptomatic hernias. Symptomatic hiatal hernias and those with confirmed reflux disease require operative repair with an anti-reflux procedure. Key operative steps include the following: reduction and excision of hernia sac, 3 cm of intraabdominal esophageal length, crural closure with mesh reinforcement, and an anti-reflux procedure. Repairs not amenable to key steps may undergo gastropexy and gastrostomy placement as an alternative procedure. Conclusions: Hiatal hernias are commonly incidental findings. When hernias become symptomatic or have reflux disease, an operative repair is required. A minimally invasive approach is safe and has improved outcomes.
Original language | English (US) |
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Pages (from-to) | 1145-1151 |
Number of pages | 7 |
Journal | Langenbeck's Archives of Surgery |
Volume | 402 |
Issue number | 8 |
DOIs | |
State | Published - Dec 1 2017 |
Keywords
- Giant paraesophageal hernias
- Hiatal hernia
- Laparoscopic hernia repair
- Paraesophageal hernia
- Sliding hernia
ASJC Scopus subject areas
- Surgery