From the Guidelines
The most feared complication of a paraesophageal hernia is strangulation, which can lead to gastric ischemia, necrosis, and perforation if not promptly addressed. This complication is a surgical emergency that requires urgent intervention to prevent significant morbidity and mortality 1. The risk of strangulation is high in paraesophageal hernias, and it is estimated that if left untreated, it can result in a mortality rate of up to 30%. Other significant complications of paraesophageal hernias include:
- Bleeding from mucosal erosions or ulcerations
- Obstruction causing dysphagia or early satiety
- Respiratory complications from compression of the lungs
- Chronic acid reflux leading to esophagitis, Barrett's esophagus, or strictures
According to the World Journal of Emergency Surgery 1, early surgical intervention is critical in preventing these complications, particularly strangulation. The study highlights the importance of prompt diagnosis and treatment of complicated abdominal wall hernias, including paraesophageal hernias. The use of mesh in emergency hernia repair is also discussed, with the study noting that while mesh use has clear advantages in elective cases, its use in emergency settings is more complex due to the risk of surgical site contamination and recurrence 1.
In patients with paraesophageal hernias, it is essential to educate them about warning signs that require immediate medical attention, including sudden severe pain, persistent vomiting, or inability to swallow. Treatment typically involves surgical reduction of the hernia, repair of the diaphragmatic defect, and often a fundoplication procedure to prevent reflux 1.
From the Research
Common Complications of Paraesophageal Hernia
The common complications of paraesophageal hernia include:
- Gastric volvulus
- Incarceration
- Strangulation
- Severe bleeding
- Perforation
- Respiratory failure
- Systemic sepsis 2, 3
Risk of Complications
The risk of complications is higher in patients who require emergent repair compared to those who undergo elective operations 4. However, with advancements in surgical techniques, such as laparoscopic repair, the morbidity and mortality rates have decreased 2, 5.
Specific Complications
- Gastric ischemia leading to perforation is a main cause of mortality 5
- Incarceration and strangulation are rare but life-threatening complications 3, 6
- Distal oesophageal perforation is a rare complication of incarcerated paraoesophageal hernia 6
Management of Complications
- Laparoscopic repair is a safe and feasible approach for acute paraesophageal hernia with low morbidity and mortality 2
- A combined laparoscopic and endoscopic approach can be used to manage incarcerated paraoesophageal hernia complicated with distal oesophageal perforation 6
- Elective repair is recommended for all paraesophageal hernias, especially in younger patients who are otherwise good operative candidates 4