From the Guidelines
The most feared complication in a patient with paraesophageal hernia is strangulation, which can lead to ischemia, necrosis, and perforation if not promptly addressed. This complication is a surgical emergency that requires urgent intervention to prevent severe consequences, including high morbidity and mortality rates 1. The risk of strangulation is a significant concern because it can occur suddenly and without warning, making it essential to monitor patients with paraesophageal hernias closely.
Some key points to consider in managing paraesophageal hernias include:
- Strangulation can lead to bacterial translocation and intestinal wall necrosis, potentially resulting in bowel perforation 1
- Delayed diagnosis of hernia with obstruction can result in the need for bowel resection with prolonged recovery and increased complication rate 1
- Elective surgical repair is often recommended for symptomatic patients or those with large hernias to prevent life-threatening complications, including strangulation
- The mortality rate from emergency surgery for complicated paraesophageal hernias is significantly higher than that of elective repair, highlighting the importance of timely intervention 1
In the context of real-life clinical medicine, it is crucial to prioritize the prevention of strangulation and other life-threatening complications in patients with paraesophageal hernias. Early surgical intervention is critical in preventing severe consequences, and elective repair should be considered for symptomatic patients or those with large hernias. By prioritizing timely intervention and monitoring, clinicians can reduce the risk of morbidity and mortality associated with paraesophageal hernias 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