Management of paraesophageal hernia 2025.

Abstract

Purpose of review: A paraesophageal hernia (PEH) is the condition in which the fundus of the stomach protrudes through the diaphragmatic hiatus into the chest adjacent to the esophagus. Such hernias can result in serious complications such as bleeding, obstruction, ischemia, and perforation. There is considerable controversy regarding the optimal management of PEH and, in this report, we review recent publications that address this issue.

Recent findings: After surgical repair of PEH, the rate of recurrence remains high, and recent data do not document a clear advantage for the use of a mesh for crural buttressing in preventing recurrence. There also appears to be no significant difference among different types of mesh for preventing recurrence in the long term. The optimal shape, positioning, and material for mesh remain controversial topics. Recent reports suggest benefit for performing gastropexy routinely during PEH repair, and the addition of a fundoplication does not seem to reduce rates of recurrence or gastroesophageal reflux. Promising early results have been described for new techniques of PEH repair such as the use of posterior rectus sheath fascia for hiatal augmentation, and anterior crural reconstruction.

Summary: This report summarizes the most recent data on key issues in the management of PEH such as the use of mesh, gastropexy, fundoplication, the role of age, and novel techniques for PEH repair.