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A 20-year prospective follow-up of childhood hiatal hernia

R Astley, I J Carré, R Langmead-Smith

    The British Journal of Radiology
    |June 1, 1977
    PubMed

    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.

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