From the Guidelines
Hiatal hernias should be treated by general surgeons when surgical intervention is necessary, as they are best equipped to perform procedures like laparoscopic fundoplication, which is often utilized in non-obese patients 1. When considering the management of hiatal hernias, it's crucial to evaluate the severity of the condition and the symptoms presented by the patient.
- For patients with mild to moderate symptoms, gastroenterologists (GI specialists) typically manage the condition with medications and lifestyle modifications.
- However, when hiatal hernias are large, cause severe symptoms, or lead to complications, general surgeons become involved to perform surgical repair. The choice between GI and general surgery involvement depends on the need for surgical intervention, with general surgeons playing a critical role in procedures like laparoscopic fundoplication, which is effective in non-obese patients 1.
- Laparoscopic fundoplication is a common surgical approach that reinforces the lower esophageal sphincter and returns the stomach to its proper position below the diaphragm.
- The treatment pathway typically begins with GI evaluation and medical management, with referral to general surgery if these measures prove insufficient. In patients with proven GERD, laparoscopic fundoplication and magnetic sphincter augmentation are effective surgical options, and transoral incisionless fundoplication is an effective endoscopic option in carefully selected patients 1.
- Candidacy for invasive antireflux procedures includes confirmatory evidence of pathologic GERD, exclusion of achalasia, and assessment of esophageal peristaltic function 1.
From the Research
Treatment of Hiatal Hernia
- Hiatal hernias are typically treated by general surgery, with a focus on operative repair and anti-reflux procedures 2, 3.
- The treatment approach is guided by the patient's symptoms, and asymptomatic hiatal hernias may be managed with watchful waiting 2.
- Symptomatic hiatal hernias and those with confirmed reflux disease require operative repair, which may include reduction and excision of the hernia sac, crural closure with mesh reinforcement, and an anti-reflux procedure 2.
Role of GI Specialists
- Gastrointestinal (GI) specialists may be involved in the diagnosis and management of hiatal hernias, particularly in cases where gastroesophageal reflux disease (GERD) is a primary symptom 4, 5.
- However, the surgical treatment of hiatal hernias is typically performed by general surgeons, with GI specialists playing a supportive role in diagnosis and medical management 2, 3.
Surgical Approaches
- Minimally invasive approaches to hiatal hernia repair are safe and have improved outcomes, with key operative steps including reduction and excision of the hernia sac, crural closure with mesh reinforcement, and an anti-reflux procedure 2.
- The use of mesh augmentation in hiatal hernia repair is a topic of ongoing debate, with some studies suggesting that it may reduce recurrence rates 3.