Clinical Ramifications of Giant Paraesophageal Hernias Are Underappreciated: Making the Case for Routine Surgical Repair

Changes in lung volumes and gas trapping in patients with large hiatal hernia

“…Patients with large hiatal hernia (HH) are frequently affected by dyspnoea, although the association is seldom recognized clinically (1). Some studies have reported a correlation between dyspnoea and increasing hernia size as well as a symptomatic improvement following surgical repair, suggesting a direct causal relationship between dyspnoea and the space-occupying effect of the hernia (2)(3)(4).…”

Repair of Paraesophageal Hiatal Hernias–Is a Fundoplication Needed? A Randomized Controlled Pilot Trial

“…Therefore, the higher incidence of reflux symptoms in LMAH-C patients did not seem to affect the overall quality of life. This might be explained by the fact, that PEH patients suffer from various symptoms, 24 and postoperative reflux control is not the leading criterion for treatment success, as in typical GERD patients. Additionally, PPIs provide an effective drug therapy with few side effects.…”

Giant Hiatus Hernia and Association with Gastro-Oesophageal Reflux: A Review

“…In a number of cohort studies where patients were selected to have a GHH repair it has been reported that: 80% to 92% of preoperative symptoms resolve [2,40]; there is an improved gastro-intestinal quality of life [37,40,41]; there is an objective improvement in pulmonary function [35] and there is an objective improvecy towards a lower mean LOS pressure/tone, reduced LOS length and reduced intra-abdominal length of LOS contributing to the increased likelihood of GORD [22][23][24][25]28,30]. It is important to note that some patients with GHH have normal LOS pressures, which may explain why reflux is not always a major symptom in this group of patients [22,30].…”

“…Open repair is still advocated in some centres with one group suggesting a lower long-term recurrence rate [2,19,35,38]. A recent series of 270 patients who underwent open repair reported no post-operative mortality, but post-operative morbidity was 38% and the median length of stay 4 days [2].…”

“…The hernia typically contains the stomach to varying degrees but may include other organs such as the omentum, colon, liver, pancreas and spleen. The term "Giant Hiatus Hernia" (GHH) has been variably defined, but most authors refer to at least 30% of the stomach, with or without other abdominal viscera, protruding through the oesophageal hiatus of the diaphragm into the mediastinum [1][2][3][4][5][6]. Symptoms arise due to dysfunction of reported to be between 8-80% [20,21,23,24].…”