Related Experiment Videos
A 20-year prospective follow-up of childhood hiatal hernia
Insights
Most children with hiatal hernias causing vomiting remain symptom-free long-term without surgery, though recurrence is possible. Surgical intervention for hiatal hernias and strictures showed poorer long-term outcomes.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes Research
Background:
- Small hiatal hernias can cause vomiting in children.
- Long-term outcomes for pediatric hiatal hernias are not well-established.
Purpose of the Study:
- To evaluate the long-term prognosis of children with vomiting due to small hiatal hernias.
- To compare outcomes between operated and non-operated patients, and between different hernia types.
Main Methods:
- Prospective follow-up of 113 children diagnosed with small hiatal hernias causing vomiting.
- Clinical and radiological review conducted 20+ years after initial diagnosis.
- Comparison of symptom status based on treatment (surgical vs. non-surgical) and presence of esophageal strictures.
Main Results:
- Over 90% of unoperated, non-stricture patients were asymptomatic at long-term follow-up.
- Only 44% of patients with strictures and/or surgical treatment were asymptomatic.
- Locular hiatal hernias had a slightly better prognosis than tubular types.
- Esophageal strictures sometimes resolved without surgery, while radical surgery yielded disappointing results.
Conclusions:
- Non-operative management appears favorable for pediatric hiatal hernias causing vomiting, particularly in the absence of strictures.
- Surgical treatment and the presence of strictures are associated with less favorable long-term outcomes.
- Further extended follow-up into adulthood is warranted to assess potential symptom recurrence.
Abstract:
A long-term prospective follow-up of 113 children with vomiting due to a small hiatal hernia is described. When reviewed by the same clinical and radiological observers 20 or more years later, over 90% of unoperated non-stricture patients were asymptomatic whereas only 44% of the stricture and/or surgically treated group were without symptoms. Half or possibly more of the asymptomatic patients still had a hernia and it is possible that these may suffer a recurrence of symptoms later in adult life. The loculus of thoracic stomach tended to retain the same shape; there was a slightly better prognosis for the locular type of hernia compared with the tubular type. Complicating oesophageal strictures can decrease or disappear without surgery other than dilatation; the results of treatment by radical surgery were disappointing. There is need for an even more prolonged follow-up into later adult life.