Hiatal hernia and anemia: a single-center experience

Hiatal hernia (HH) is an often overlooked cause of chronic anemia, and the therapeutic role of surgical HH repair (HHr) in these cases remains underexplored. Thus, we assessed the prevalence of anemia and visible Cameron lesions in patients undergoing primary HHr, explored associations with hernia size, and evaluated objective postoperative improvements.

This retrospective, observational study used a prospectively maintained surgical database at a high-volume tertiary referral center to identify patients with anemia or upper gastrointestinal bleeding who underwent HHr between September 2016 and March 2024. Adults who underwent HHr with (i) preoperative anemia (hemoglobin <13.0 g/dL for men or <12.0 g/dL for women), (ii) endoscopic evidence of Cameron lesions, (iii) documented anemia in medical records, or (iv) documented history of iron deficiency anemia-related therapies were included. Patients with prior foregut procedures or other identifiable sources of blood loss were excluded. The primary endpoints were the rates of postoperative transfusion-level anemia and iron deficiency anemia-related therapies.

Among 448 patients who underwent primary HHr, 132 (29.5%) were included. The rates of anemia-related findings increased with HH size as follows: small, 7.3%; moderate, 28.7%; large, 58.4%; and intrathoracic stomach, 44.7%. Significant reductions were seen in postoperative rates of transfusion-level anemia (15.2% to 0%; P =.004) and anemia-related medical therapies (50.8% to 2.2%; P <.001).

Anemia and/or visible Cameron lesions are common in patients undergoing HHr and increase with hernia size. HHr significantly reduces transfusion-level anemia and the need for anemia-related therapies. Early surgical referral should be considered, as medical treatment alone may not address the underlying causes.