Modern diagnosis and treatment of hiatal hernias. Review uri icon

Overview

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.

publication date

  • August 21, 2017

Research

keywords

  • Hernia, Hiatal
  • Herniorrhaphy

Identity

Scopus Document Identifier

  • 85027962220

Digital Object Identifier (DOI)

  • 10.1007/s00423-017-1606-5

PubMed ID

  • 28828685

Additional Document Info

volume

  • 402

issue

  • 8