Highlights & Basics
- Hiatal hernia may be asymptomatic or may present with heartburn, dysphagia, odynophagia, hoarseness, asthma, shortness of breath, chest pain, anemia or hematemesis, or a combination of these.
- Common risk factors are obesity and increased age. Other known risk factors include intra-abdominal pressure from various conditions, and a previous hiatal operation.
- Contrasted upper gastrointestinal (GI) series (also known as an upper GI or as a barium esophagram) is the key investigation technique and aids the surgeon in characterizing any anatomic variation necessary for preoperative evaluation. Computed tomography scanning with 3-dimensional reconstruction can be helpful if the diagnosis is unclear, or when planning surgery.
- The necessity for, and type of treatment, depends on the patient's symptoms and the anatomic configuration of the hernia.
- Uncomplicated sliding hiatal hernias are treated symptomatically with medical therapy, although some patients may select surgical therapy. Complicated hiatal hernias (those with bleeding, volvulus, or obstruction) have a stronger indication for surgical repair.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Society of American Gastrointestinal and Endoscopic Surgeons. Guidelines for the management of hiatal hernia. April 2013 [internet publication].[Full Text]
Roman S, Kahrilas PJ. The diagnosis and management of hiatus hernia. BMJ. 2014 Oct 23;349:g6154.[Abstract]
Sfara A, Dumitrascu DL. The management of hiatal hernia: an update on diagnosis and treatment. Med Pharm Rep. 2019 Oct;92(4):321-25.[Abstract][Full Text]
Müller-Stich BP, Holzinger F, Kapp T, et al. Laparoscopic hiatal hernia repair: long-term outcome with the focus on the influence of mesh reinforcement. Surg Endosc. 2006 Mar;20(3):380-4.[Abstract]
Johnson JM, Carbonell AM, Carmody BJ, et al. Laparoscopic mesh hiatoplasty for paraesophageal hernias and fundoplications: a critical analysis of the available literature. Surg Endosc. 2006 Mar;20(3):362-6.[Abstract]
Oelschlager BK, Pellegrini CA, Hunter J, et al. Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg. 2006 Oct;244(4):481-90.[Abstract][Full Text]
Antoniou SA, Müller-Stich BP, Antoniou GA, et al. Laparoscopic augmentation of the diaphragmatic hiatus with biologic mesh versus suture repair: a systematic review and meta-analysis. Langenbecks Arch Surg. 2015 Jul;400(5):577-83.[Abstract]
Frantzides CT, Carlson MA, Zografakis JG, et al. Postoperative gastrointestinal complaints after laparoscopic Nissen fundoplication. JSLS. 2006 Jan-Mar;10(1):39-42.[Abstract][Full Text]
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