From the Research
Treatment Options for Hiatal Hernia
- Laparoscopic surgery is considered the gold standard of treatment for giant hiatal hernias (GHHs) and is a viable and safe procedure 1
- Surgical treatment of hiatal hernia can be performed laparoscopically, involving plication of the esophageal hiatus, as well as a pexy of the esophagus to the diaphragm and a left-sided gastropexy 2
- Laparoscopic Nissen fundoplication is often considered the standard for treating gastroesophageal reflux disease-related hiatal hernia due to its effectiveness 3
Surgical Techniques
- Key operative steps for hiatal hernia repair include reduction and excision of hernia sac, 3 cm of intraabdominal esophageal length, crural closure with mesh reinforcement, and an anti-reflux procedure 4
- Repairs not amenable to key steps may undergo gastropexy and gastrostomy placement as an alternative procedure 4
- Modified Collis gastroplasty can be used as an esophageal lengthening procedure in some patients 5
Outcomes and Complications
- Outcomes with laparoscopic treatment are comparable to those performed via laparotomy 2
- Laparoscopic repair of hiatal hernia is a feasible technique with a satisfactory surgical outcome, with a low rate of postoperative complications and recurrence 5
- Asymptomatic hiatal and paraesophageal hernias become symptomatic and necessitate repair at a rate of 1% per year, and watchful waiting is appropriate for asymptomatic hernias 4