Materiały źródłowe

• #1 Hiatal Hernia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562200/

  The incidence of hiatal hernias increases with age. Approximately 55% to 60% of individuals older than 50 have a hiatal hernia. However, only about 9% have symptoms, with the manifestations depending on the type and competence of the LES. The vast majority of these hernias are type I sliding hiatal hernias. Type II paraesophageal hernias only comprise about 5% of hiatal hernias where the LES remains stationary, but the stomach protrudes above the diaphragm. The condition’s prevalence is also increased in women, which may be attributed to elevated intraabdominal pressure during pregnancy. Hiatal hernias are most common in Western Europe and North America and are rare in rural Africa.

• #2 Hiatal Hernia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22859

  The incidence of hiatal hernias increases with age. Approximately 55% to 60% of individuals older than 50 have a hiatal hernia. However, only about 9% have symptoms, with the manifestations depending on the type and competence of the LES. The vast majority of these hernias are type I sliding hiatal hernias. Type II paraesophageal hernias only comprise about 5% of hiatal hernias where the LES remains stationary, but the stomach protrudes above the diaphragm. The condition’s prevalence is also increased in women, which may be attributed to elevated intraabdominal pressure during pregnancy. Hiatal hernias are most common in Western Europe and North America and are rare in rural Africa. […] Hiatal hernias may be congenital or acquired. The condition’s prevalence is increased among older people. Muscle weakness due to age-related loss of flexibility and elasticity is believed to be a predisposing factor to the development of a hiatal hernia. The hernia may prevent the upper part of the stomach from returning to its natural position below the diaphragm during swallowing. Other predisposing factors have been identified, such as elevated intraabdominal pressure, which typically arises from obesity, pregnancy, chronic constipation, and chronic obstructive pulmonary disease (COPD). Trauma, age, previous surgeries, and genetics also play a role in the development of a hiatal hernia.

• #3 Hiatus Hernia: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/hiatus-hernia-pro

  The precise incidence of hiatus hernia is not known, as most studies have looked only at individuals who presented with symptoms of dyspepsia. However, it is estimated that 55-60% of over 50s have a hiatus hernia but that only 9% are symptomatic. […] Estimates for the general population vary enormously – from 10-80% of the adult population in North America, for example. It is more common amongst men. The incidence increases with age and with obesity.

• #4 The prevalence and risk factors for hiatal hernia among patients undergoing endoscopy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10187740/

  The prevalence of HH was 29.8% among all patients and 48.6% among those who underwent EGD for gastroesophageal reflux disease-related indications. […] The prevalence of HH was 28.9% based on this large endoscopy-based population. We found no association between HH and gender, age, or BMI. […] The prevalence of HH was 29.8% among patients who underwent EGD for any indication and 48.7% among those who underwent EGD for GERD-related indications. […] Although several factors are associated with the risk of developing HH, we could not establish a relationship between HH and gender, age, or BMI. […] In the present study, no association was observed between obesity, as defined by BMI, and HH, which resembles what has been reported in other studies. […] We found no association between HH and gender, age, or BMI.

• #5 The prevalence and risk factors for hiatal hernia among patients undergoing endoscopy | Saudi Medical Journal

  https://smj.org.sa/content/44/5/509

  Objectives: To determine the prevalence of hiatal hernia (HH) and its association with age, gender, and body mass index (BMI). […] The prevalence of HH was 29.8% among all patients and 48.6% among those who underwent EGD for gastroesophageal reflux disease-related indications. […] The prevalence of HH was 28.9% based on this large endoscopy-based population. We found no association between HH and gender, age, or BMI. […] In this large study, we found the prevalence of HH was 29.8% among patients who underwent EGD for any indication and 48.7% among those who underwent EGD for GERD-related indications. […] Although several factors are associated with the risk of developing HH, we could not establish a relationship between HH and gender, age, or BMI. […] In our study, the prevalence of HH was similar in men (28.6%) and women (30.5%).

• #6 Hiatal hernia prevalence and natural history on non-contrast CT in the Multi-Ethnic Study of Atherosclerosis (MESA) | BMJ Open Gastroenterology

  https://bmjopengastro.bmj.com/content/8/1/e000565

  Objective To determine the prevalence, risk factors and natural history of hiatal hernia (HH) on CT in the general population. […] Excellent interobserver agreement was found for presence (=0.86) and type of HH (=0.97). Among 316 HH identified (prevalence=9.9%), 223 (71%) were type I and 93 (29%) were type III. HH prevalence increased with age, from 2.4% in 6th decade to 16.6% in 9th decade (unadjusted prevalence ratio (PR)=1.1 (95% CI 1.04 to 1.1)). HH prevalence was greater in women (12.7%) than men (7.0%) (unadjusted PR=1.8 (95% CI 1.5 to 2.3)) and associated with proton pump inhibitor use (p0.001). […] HH on non-contrast CT is prevalent in the general population, increasing with age, female gender and BMI. Its association with proton pump inhibitor use confirms a role in gastro-oesophageal reflux disease and HH progression is associated with increased BMI.

• #7 Hiatal hernia prevalence and natural history on non-contrast CT in the Multi-Ethnic Study of Atherosclerosis (MESA) | BMJ Open Gastroenterology

  https://bmjopengastro.bmj.com/content/8/1/e000565

  Non-contrast CT on 3200 Multi-Ethnic Study of Atherosclerosis subjects followed up over 10 years shows HH prevalence in the general population (aged 5394 years) increases with ageing from 2.4% in the sixth decade of life to 7.0%, 14.0% and 16.6% in seventh, eighth and ninth decades, respectively and is more common in women (PR=1.8) and in those with obesity (PR=1.1). […] Finding HH on chest CT raises the likelihood of gastro-oesophageal reflux disease and patients with high BMI have an association with HH progression. […] Our study also showed significant associations between BMI and HH prevalence, which is in agreement with findings from the prior literature. […] The significant difference in BMI between the groups of participants with progression of HH (ie, HH area increased 10% over 10 years) and improvement of HH (ie, HH area decreased 10% or HH spontaneously resolved) raises the possibility that obesity, which increases intra-abdominal pressure, may play a role in the development and progression of HH. […] Our data here showing incidence of HH over a 10-year interval correlating with loss of height over the same time interval supports this hypothesis.

• #8 Hiatal Hernia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/178393-overview

  Hiatal hernias are more common in Western countries. The frequency of hiatus hernia increases with age, from 10% in patients younger than 40 years to 70% in patients older than 70 years. […] Burkitt et al suggest that the Western, fiber-depleted diet leads to a state of chronic constipation and straining during bowel movement, which could explain the higher incidence of this condition in Western countries. […] Hiatal hernias are more common in women than in men. This might relate to the intra-abdominal forces exerted in pregnancy. […] Muscle weakening and loss of elasticity as people age is thought to predispose to hiatus hernia, based on the increasing prevalence in older people. With decreasing tissue elasticity, the gastric cardia may not return to its normal position below the diaphragmatic hiatus following a normal swallow. Loss of muscle tone around the diaphragmatic opening also may make it more patulous.

• #9 Hiatal hernia – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/hiatal-hernia/

  Epidemiological data refers to the US, unless otherwise specified. […] Incidence increases with: Age: affects 70% of people 70 years […] BMI.

• #10 Hiatal Hernia: What It Is, Symptoms, Treatment & Surgery

  https://my.clevelandclinic.org/health/diseases/8098-hiatal-hernia

  Hiatal hernias are common, especially as you get older. In the U.S., they affect about 20% of the general population. They affect 50% over the age of 50, 60% over the age of 60 and 70% over the age of 70. […] Most arent serious. Most dont even cause symptoms. You may never know that you have one. But a larger hernia could eventually become serious. Youd probably have symptoms if you had a larger one. […] The most common problem that hiatal hernias cause is chronic acid reflux. Chronic acid reflux can do damage to your esophagus over time, if its severe and medications dont manage it well enough. […] Healthcare providers find hiatal hernias by looking at images of your esophagus and stomach. Sometimes, they find it accidentally while looking for something else. If theyre looking for it, its usually because you have symptoms of acid reflux.

• #11 Hiatus hernia | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/hiatus-hernia?embed_domain=external.radpair.com%252527%25255B0%25255D%252527%25255B0%25255Dfavicon.ico&lang=us

  The prevalence of hiatus hernia increases with age, with a slight female predilection. […] Symptomatic hiatus hernias, especially types 2-4, should be managed surgically.

• #12 Hiatus hernia epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Hiatus_hernia_epidemiology_and_demographics

  Hiatus hernias affect around 1 to 20% of the population. Out of this 9 % are symptomatic, depending on the ability of the lower esophageal sphincter (LES). Approximately 95% of these categorize under „sliding” hiatus hernias, in which the lower esophageal sphincter protrudes above the diaphragm along with the stomach, and only 5% is the „rolling” type (paraesophageal), in which the lower esophageal sphincter (LES) remains stationary but the stomach protrudes above the diaphragm. A hiatus hernia is more common in older people. […] It is estimated that greater than 95 percent of hiatus hernias are type I (sliding) hiatus hernia. […] Approximately 5 percent of the hiatus hernias are with type II, III, and IV (paraesophageal) hernias. […] Hiatus hernias commonly affects individuals older than 50 years of age. […] There is no racial predilection to hiatus hernia. […] Women are more commonly affected by Hiatus hernias than men.

• #13 The prevalence and risk factors for hiatal hernia among patients undergoing endoscopy | Saudi Medical Journal

  https://smj.org.sa/content/44/5/509

  In the present study, no association was observed between obesity, as defined by BMI, and HH, which resembles what has been reported in other studies. […] The strengths of our study include the fact that it is the largest study to date to report the prevalence of HH in the Saudi population. […] In conclusion, the prevalence of HH in the Saudi population was 28.9% in this large endoscopy-based population. We found no association between HH and gender, age, or BMI.

• #14 Hiatal hernia – Wikipedia

  https://en.wikipedia.org/wiki/Hiatal_hernia

  Incidence of hiatal hernias increases with age; approximately 60% of individuals aged 50 or older have a hiatal hernia. Of these, 9% are symptomatic, depending on the competence of the lower esophageal sphincter (LES). 95% of these are „sliding” hiatal hernias, in which the LES protrudes above the diaphragm along with the stomach, and only 5% are the „rolling” type (paraesophageal), in which the LES remains stationary, but the stomach protrudes above the diaphragm. […] Hiatal hernias are most common in North America and Western Europe and rare in rural African communities. Some have proposed that insufficient dietary fiber and the use of a high sitting position for defecation may increase the risk.

• #15 Hiatal hernia – epidemiology, pathogenesis, diagnostic • Postępy Nauk Medycznych 5/2018 • Czytelnia Medyczna BORGIS

  https://www.czytelniamedyczna.pl/6473,hiatal-hernia-epidemiology-pathogenesis-diagnostic.html

  Hiatal hernia epidemiology, pathogenesis, diagnostic Przepukliny przeponowe epidemiologia, patogeneza, diagnostyka Przepuklina rozworu przeykowego jest czst patologi, a czsto wystpowania ronie wraz z wiekiem. Przeanalizowano epidemiologi wystpowania przepuklin rozworu przeykowego, ich patogenez, symptomatologi, najczciej stosowane metody diagnostyczne oraz moliwoci terapeutyczne. Epidemiology The frequency of occurrence of hiatal hernia increases along with age. Actual frequency of occurrence of hiatal hernia may only be estimated due to the fact that it brings only mild or no symptoms, and diagnostic criteria may differ. Clinical estimations report that approximately 50-60% of patients over 50 years old suffer from hiatal hernia. The frequency of occurrence of symptomatic cases of hiatal hernia is strictly connected with the recognition of gastroesophageal reflux disease (GERD) due to the fact that both those conditions are strongly correlated. Approximately 9% of hiatal hernias are symptomatic. Sliding hiatal hernia (type I) are significantly more frequent and consist of 90-95% of cases, esophageal type (type II) consists of only 5% where LES remains below the diaphragm and the stomach is relocated to the thorax. Hiatal hernias occur the most frequently in highly developed countries of Northern America and Western Europe, and the most rarely in African and Eastern populations.

• #16 Which hiatal hernia’s need to be fixed? Large, small or none? – Dunn – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/5885/html

  Hiatal hernias are a common occurrence in the western population, with an estimated prevalence of 15% to 20%. […] The current body of literature is constantly expanding, with new evidence for and against aggressive repair of these hernias appearing on a monthly basis. […] The prevalence of hiatal hernia varies in the literature from 15-20% in western populations. […] Type II-IV hiatal hernias are commonly grouped together and called para-esophageal hernias (PEH). […] Large paraesophageal hernias (PEHs) predispose to gastric volvulus with potential necrosis of the stomach secondary to impaired blood flow in gastric vessels. […] Surgery is recommended for all acute symptomatic presentations of PEHs (obstruction or incarceration/strangulation). […] Type I hiatal hernias are not typically surgically repaired if they are asymptomatic, given their low overall morbidity.

• #17 Literature Review: A Surgeon’s View of Recurrent Hiatal Hernia

  http://www.scielo.org.co/scielo.php?pid=S0120-99572015000400008&script=sci_arttext&tlng=en

  Recurrent hiatal hernias are a common pathology that generate a diagnostic and therapeutic challenge for surgeons and gastroenterologists. […] More than 95% of primary hiatal hernias are Type I sliding hernias. Types II, III and IV are grouped as para-esophageal hernias. Of these, over 90% are type III. Type II is the least common. […] The incidence of recurrence of hiatal hernia after repair of a primary sliding hiatal hernia in patients with gastroesophageal reflux is difficult to determine since not all patients who have undergone anti-reflux surgery have had esophagograms prior to the procedure, and since sometimes patients develop sliding hiatal hernias as the result of the release of attachments during surgery. […] Rates from 2% to 42% have been reported for recurrence of para-esophageal hiatal hernias, but the types of procedures performed and the follow-up times vary widely. […] These studies suggest a high rate of relapse with a direct relationship to the length of time after the original procedure, but also suggest that very few patients require a new procedure.

• #18 Pulsenotes | Hiatus hernia

  https://app.pulsenotes.com/medicine/gastroenterology/notes/hiatus-hernia

  Hiatus hernia is an extremely common anatomical abnormality. […] There is a huge variation in the prevalence of hiatus hernia. […] Traditional risk factors for hiatus hernia include older age, male sex, and obesity. […] In one study, the prevalence of hiatus hernia was 9.9% among 3200 patients undergoing CT imaging.

• #19 Surgical management of paraesophageal hernia – UpToDate

  https://www.uptodate.com/contents/surgical-management-of-paraesophageal-hernia

  Paraesophageal hernias (PEH) are most common in older adults, particularly females, although they are increasingly seen in younger people and males. Consequently, PEHs are becoming increasingly common as the population ages. Kyphosis is a major risk factor, and these hernias are also more common in people with a history of other abdominal hernias such as inguinal, umbilical, or ventral hernias. […] Unlike sliding hiatal hernias, there is no medical management for PEH. Surgical treatment of PEH will be reviewed here. […] The four types of hiatal hernias can be distinguished by the hernia contents and the position of the gastroesophageal junction (GEJ). Sliding hernias are associated with gastroesophageal reflux disease (GERD), but only a PEH has the potential to develop acute hernia-related complications such as obstruction, ischemia, or perforation. When more than 50 percent of the stomach has herniated into the chest, a PEH is often referred to as a „giant” PEH.

• #20

  https://step2.medbullets.com/gastrointestinal/120143/hiatal-hernia

  Epidemiology […] Incidence […] under detected due to asymptomatic hernias […] […] […] Demographics […] majority are 50 years of age […] […] […] Risk factors […] obesity […] older age […] trauma […] valsalva

• #21 Clinical Significance of Hiatal Hernia

  https://www.gutnliver.org/journal/view.html?volume=5&number=3&spage=267

  Hiatal hernias can be diagnosed radiographically, endoscopically or manometrically, with each modality having its own limitations, especially in the diagnosis of hiatal hernias less than 2 cm in length. […] In the future, high resolution manometry should be a promising method for accurately assessing the association between hiatal hernias and GERD. […] The treatment of a hiatal hernia is similar to the management of GERD and should be reserved for those with symptoms attributable to this condition. […] Many studies have demonstrated that hiatal hernia is closely related to reflux symptoms, reflux esophagitis, Barrett’s esophagus and esophageal adenocarcinoma. […] Patients with hiatal hernia are significantly more likely to present with GERD symptoms than those without hiatal hernia, and symptomatic GERD patients are more likely to have hiatal hernias compared to those without symptoms.

• #22 Clinical Significance of Hiatal Hernia

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=284&vmd=Full

  Hiatal hernias can be diagnosed radiographically, endoscopically or manometrically, with each modality having its own limitations, especially in the diagnosis of hiatal hernias less than 2 cm in length. […] In the future, high resolution manometry should be a promising method for accurately assessing the association between hiatal hernias and GERD. […] The treatment of a hiatal hernia is similar to the management of GERD and should be reserved for those with symptoms attributable to this condition. […] Many studies have demonstrated that hiatal hernia is closely related to reflux symptoms, reflux esophagitis, Barrett’s esophagus and esophageal adenocarcinoma. […] Patients with hiatal hernia are significantly more likely to present with GERD symptoms than those without hiatal hernia, and symptomatic GERD patients are more likely to have hiatal hernias compared to those without symptoms.

• #23 Atypical and typical manifestations of the hiatal hernia – Goodwin – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/6254/html

  Hiatal hernias may present in variety of ways, both typical and atypical. Manifestations are dependent on the type and size of the hernia. Gastrointestinal manifestations are the most common, predominately with GERD and associated syndromes. The true incidence and prevalence of hiatal hernia is difficult to quantify, as many patients remain asymptomatic and undiagnosed from the hernia. The presence of a hiatal hernia is closely related to reflux symptoms and associated complications. Patients with a hiatal hernia are significantly more likely to present with GERD symptoms compared to those without a hiatal hernia. Furthermore, symptomatic GERD patients are more likely to have a hiatal hernia than those without symptoms. GERD symptoms are more common in Type 1 hiatal hernias, and the size of the hernia can impact symptom severity. The strong association between hiatal hernia and GERD syndromes implies that many of the atypical presentations of GERD may manifest in a hiatal hernia. These atypical manifestations are often extraesophageal and rarely occur in isolation without concurrent typical symptoms of GERD. Hiatal hernias can disturb gastrointestinal filling, receptive relaxation, or continuity and produce various gastrointestinal obstructive symptoms. Typical obstructive gastrointestinal symptoms of a hiatal hernia include early satiety, nausea, and bloating. Atypical gastrointestinal obstructive manifestations of a hiatal hernia occur with less frequency. Other atypical manifestations of a hiatal hernia include gastrointestinal bleeding and anemia. Hiatal hernias can present with non-gastrointestinal symptoms, obscuring the diagnosis in such patients on initial presentation. Typical pulmonary symptoms with hiatal hernia include dyspnea and atelectasis as a result of pulmonary compression. The increased prevalence of GERD with hiatal hernias contribute to the association of a hiatal hernia with pulmonary fibrosis. In a large population-based study, hiatal hernias were associated with an increased prevalence of atrial fibrillation.

• #24 Clinical Significance of Hiatal Hernia

  https://www.gutnliver.org/journal/view.html?volume=5&number=3&spage=267

  The prevalence of hiatal hernia also increased with the length of Barrett’s esophagus and the size of hiatal hernia was larger in those with Barrett’s esophagus compared to those without. […] Moreover, it was shown that development and progression to Barrett’s esophagus with high-grade dysplasia or adenocarcinoma was significantly and independently related to the size of hiatal hernia. […] The presence of hiatal hernia more than doubled the risk of developing adenocarcinoma of the esophagus and gastric cardia. […] The presence of hiatal hernia per se is not an indication for treatment, and therapy should be given to those with symptoms attributable to this condition.

• #25 Clinical Significance of Hiatal Hernia

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=284&vmd=Full

  The prevalence of hiatal hernia also increased with the length of Barrett’s esophagus and the size of hiatal hernia was larger in those with Barrett’s esophagus compared to those without. […] Moreover, it was shown that development and progression to Barrett’s esophagus with high-grade dysplasia or adenocarcinoma was significantly and independently related to the size of hiatal hernia. […] The presence of hiatal hernia more than doubled the risk of developing adenocarcinoma of the esophagus and gastric cardia. […] The presence of hiatal hernia per se is not an indication for treatment, and therapy should be given to those with symptoms attributable to this condition. […] Surgical management should encompass both the correction of hiatal hernia by restoring the intra-abdominal esophagus and reconstructing the diaphragmatic hiatus, and reinforcement of the LES by antireflux procedure with Nissen fundoplication being the most frequently employed measure.

• #26 Surgical strategies for recurrent hiatal hernia: three-point fundoplication fixation | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-025-02760-9

  Recurrence of hiatal hernia is the main cause of hiatal hernia reoperation, and it is also a challenge for surgeons. […] According to a study of 307 patients, the incidence of symptomatic recurrence of hiatal hernia postoperatively was 20.8%. Another study reported that the radiologic recurrence rate of hiatal hernias was approximately 16% one year after surgery and 39% five years after surgery. […] The recurrence of hiatal hernias is closely related to the size of the primary hernia defect. It has been reported that if the defect size is greater than 5 cm, the incidence of recurrence significantly increases to approximately 16%. […] Eleven patients (84.6%) achieved complete recovery after the operation, and no symptoms or complications were recorded. Additionally, the medications were abandoned three months after the operation.

• #26 Surgical strategies for recurrent hiatal hernia: three-point fundoplication fixation | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-025-02760-9

  The management of a recurrent (symptomatic) hiatal hernia remains controversial. This study aimed to review the outcomes of patients who underwent recurrent repair of hiatal hernias. […] The prevalence of GERD has now reached 13% worldwide. Hiatal hernia, a significant anatomic cause of GERD, has an incidence of up to 20%. Laparoscopic repair of hiatal hernias along with fundoplication has been proven to be the preferred treatment for GERD and hiatal hernias. However, the postoperative recurrence rate of hiatal hernias is high. It has been reported that the recurrence rates range from 25 to 42%, which may put patients at risk of reoperation. […] The results showed that fixation of the left and right sides of fundoplication with the phrenoesophageal ligament can effectively ameliorate patients symptoms and reduce the incidence of recurrence.

• #27 Which hiatal hernia’s need to be fixed? Large, small or none? – Dunn – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/5885/html

  Influential studies published more than 40 years ago led to recommendations that surgeons prophylactically repair all PEHs in order to avoid the potential development of volvulus and/or gastric ischemia. […] In recent years, however, some studies have found that the risk of catastrophic complications is much lower than these initial estimates. […] Few studies have looked at the natural history of paraesophageal hernias without surgical intervention, making it difficult to assess the risks of watchful waiting. […] The question of whether a patient should receive surgery is further complicated by the patients age and medical comorbidities. […] Current surgical techniques for elective PEH repair have documented low postoperative morbidity/mortality and favorable long-term symptomatic outcomes.

• #28

  https://link.springer.com/article/10.1007/s00464-024-10956-y

  Hiatal hernia is a common surgical pathology. […] Data on the effects of age on the outcomes of hiatal hernia repair may help inform this decision-making process. […] The vast majority of patients in both groups underwent minimally invasive operations. In the elective cohort, octogenarians had higher rates of mortality, malnutrition, sepsis, respiratory failure, pneumonia, DVT, blood transfusion, and discharge to nursing facility. In the emergent cohort, octogenarians had higher rates of mortality, malnutrition, sepsis, and respiratory failure. The odds ratios for mortality in the elective and emergent cohorts were 3.9 (95% CI 3.15.0) and 3.5 (95% CI 2.15.6), respectively. […] Octogenarians are at a meaningfully increased risk for mortality and morbidity after both elective and emergent hiatal hernia repair compared to senior-aged patients. Greater consideration should be given to surgical repair prior to the 8th decade of life.

• #29

  https://link.springer.com/article/10.1007/s00464-024-10956-y

  This retrospective study utilizing the TriNetX database found that octogenarians undergoing both elective and emergent hiatal hernia repair are at significantly increased risk for death and other complications compared to patients aged 6579. […] The results of this study strongly suggest that senior-age patients considering hiatal hernia repair would have significantly better outcomes with immediate elective repair rather than pursuing repair after age 80.

• #30 Which hiatal hernia’s need to be fixed? Large, small or none? – Dunn – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/5885/html

  These studies argue that elective surgery is safe and has favorable symptomatic outcomes. […] The results of this study highlight the poor outcomes of watchful waiting for symptomatic PEH. […] The finding from Jassim et al. for the risk associated with chronic lung disease was also identified by other studies. […] Together, the weight of evidence suggests that although part of the increased morbidity and mortality of emergency repair is explained by differences in comorbidities, there is also an independent risk associated with emergency repair. […] As such, the best course of action is a carefully held discussion between patient and surgeon on the risks and benefits of elective repair versus watchful waiting.

• #31 Hiatal Hernia: What It Is, Symptoms, Treatment & Surgery

  https://my.clevelandclinic.org/health/diseases/8098-hiatal-hernia

  Hernias dont go away. They usually get worse over time. But that doesnt mean your hernia will cause problems for you. If your hiatal hernia never causes any symptoms, you might not need to treat it. But if it does, you can expect those symptoms to continue and possibly worsen. […] Hiatal hernia surgery has a 90% success rate. Most people are able to discontinue medications and enjoy life free of acid reflux after hiatal hernia surgery.

• #32 Top Published Expert Doctors for Hiatal Hernia

  https://www.findexpertmd.com/d/Hiatal_Hernia

  873 top medical experts on Hiatal Hernia across 44 countries and 38 U.S. states, including 832 MDs (Physicians). This is based on an objective analysis of their Scientific Publications, Clinical Trials, Medicare, and NIH Grants. […] Clinical Trials: at least 53 including 4 Active, 22 Completed, 14 Recruiting.

• #33 A new technique for treating hiatal hernia with gastroesophageal reflux disease: the laparoscopic total left-side surgical approach | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-021-01356-3

  The TLSA provides a broad and clear surgical field, less trauma, and rapid recovery; moreover, it is a technically simple surgery, which may make it especially suitable for obese patients, and patients with substantial comorbidities. The findings of this study will allow for a safer and simpler treatment of patients with HH and GERD, without compromising the structure and function of the vagus nerve to a certain extent.

• #34

  https://smw.ch/index.php/smw/article/view/3114

  AIMS OF THE STUDY: Surgery for large hiatal hernias has greatly evolved over the last decade, but there is an ongoing controversy regarding many technical aspects, such as the use of meshes or the necessity to add a fundoplication. The purpose of this survey was to assess the current spectrum of surgical care for mixed axial and paraoesophageal hiatal hernias (type III hiatal hernia) in Switzerland. […] RESULTS: Forty-seven visceral surgeons with a median annual institutional caseload of 15 (interquartile range 10-30) type III hiatal hernia participated in the survey (response rate 15%). Agreement 75% was found for several basic technical steps (access via laparoscopy, hernia sac resection, preservation of vagus nerves, preservation of aberrant left hepatic artery, single-stitch posterior suture repair of hiatus with braided, non-resorbable material, complementary antireflux procedure). In contrast, consensus was not achieved for several important surgical details (mesh hiatoplasty, type of antireflux procedure, gastropexy, management of short oesophagus). A high percentage of participating surgeons experienced mesh related complications in their own or assigned patients: erosions (15% and 36%, respectively), stenoses (26% and 24%, respectively) and pericardial tamponades (9% and 15%, respectively). Nevertheless, hiatal reinforcement with mesh (in all or in selected cases) was reported by 91% of participants without consensus regarding mesh type, shape, placement and fixation technique. […] CONCLUSIONS: Apart from a few generally accepted technical steps, surgical management of type III hiatal hernia is highly variable amongst visceral surgeons in Switzerland. Although mesh-related complications appear to be common, most Swiss surgeons report routine mesh use for hiatal reinforcement.

• #35 Surgical strategies for recurrent hiatal hernia: three-point fundoplication fixation | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-025-02760-9

  Recurrent hiatal hernia repair is challenging. We present several surgical strategies for addressing this issue. Fixation of the left and right sides of fundoplication with the phrenoesophageal ligament can effectively reduce the impact on the tissue around the hiatus hernia ring to reduce the incidence of recurrence as a form of additional phrenoesophageal membrane repair.

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