What are the indications for surgical repair of paraesophageal hernias?
- In most patients with a paraesophageal hernia, it is the hernia itself that is responsible for symptoms and imparts the risk of life-threatening complications.
- There is no medical medication appropriate for treating a paraesophageal hernia.
- The only therapy for the hernia is surgical, and there used to be a controversy about which patients should have an operation and which procedure and approach are most appropriate.
- A prophylactic paraesophageal hernia repair is now rarely performed as the mortality rate after elective hernia repair in an asymptomatic patient ranges between 0.5% and 1.4%, whereas the probability of developing acute symptoms that will require emergent surgery is estimated to be 1.1%.
- However, all patients with symptoms or signs associated with the paraesophageal hernia should undergo repair in the absence of prohibitive surgical risk.
- Also, patients with gastric volvulus, obstruction, strangulation, perforation, and bleeding should undergo emergent paraesophageal hernia repair.
