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Paraoesophageal hiatal hernias: when to operate
D R Harriss1, T R Graham, M Galea
1Department of Thoracic Surgery, City Hospital, Nottingham, UK.
Journal of the Royal College of Surgeons of Edinburgh
|April 1, 1992
Summary
Symptomatic paraoesophageal hernias often present with severe complications like gastric volvulus or perforation. Early surgical repair is recommended due to the high risk of these serious issues.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Thoracic Surgery
Background:
- Paraoesophageal hernias are a less common type of diaphragmatic hernia.
- These hernias can lead to significant morbidity and mortality if left untreated.
Purpose of the Study:
- To evaluate the clinical presentation, management, and outcomes of paraoesophageal hernia cases.
- To assess the complications associated with paraoesophageal hernias and the efficacy of surgical repair.
Main Methods:
- Retrospective review of 29 paraoesophageal hernia cases treated between 1979 and 1988.
- Surgical intervention involved hernial reduction, crural repair, and antireflux procedures when indicated, primarily via a transthoracic approach.
Main Results:
- Of 29 symptomatic patients (mean age 66.3 years), 45% had complications including gastric volvulus, hemorrhage, or perforation.
- 34% showed evidence of gastro-oesophageal reflux.
- Three deaths occurred, two from hernia perforation and one post-stricture dilatation; one major complication (pulmonary embolus) resolved fully.
- No recurrences were observed during a mean follow-up of 47.6 months.
Conclusions:
- Symptomatic paraoesophageal hernias are associated with frequent and severe complications, necessitating early surgical intervention.
- The study suggests extending repair recommendations to asymptomatic paraoesophageal hernias, despite ongoing debate.