Modern diagnosis and treatment of hiatal hernias

Steve R. Siegal, James Dolan, John Hunter

Research output: Contribution to journalArticle

7 Scopus citations

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 languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalLangenbeck's Archives of Surgery
DOIs
StateAccepted/In press - Aug 21 2017

Keywords

  • Giant paraesophageal hernias
  • Hiatal hernia
  • Laparoscopic hernia repair
  • Paraesophageal hernia
  • Sliding hernia

ASJC Scopus subject areas

  • Surgery

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