Treatment and controversies in paraesophageal hernia repair.
BACKGROUND
Historically all paraesophageal hernias were repaired surgically, today intervention is reserved for symptomatic paraesophageal hernias. In this review, we describe the indications for repair and explore the controversies in paraesophageal hernia repair, which include a comparison of open to laparoscopic paraesophageal hernia repair, the necessity of complete sac excision, the routine performance of fundoplication, and the use of mesh for hernia repair.


METHODS
We searched Pubmed for papers published between 1980 and 2015 using the following keywords: hiatal hernias, paraesophageal hernias, regurgitation, dysphagia, gastroesophageal reflux disease, aspiration, GERD, endoscopy, manometry, pH monitoring, proton pump inhibitors, anemia, iron-deficiency anemia, Nissen fundoplication, sac excision, mesh, and mesh repair.


RESULTS
Indications for paraesophageal hernia repair have changed, and currently symptomatic paraesophageal hernias are recommended for repair. In addition, it is important not to overlook iron-deficiency anemia and pulmonary complaints, which tend to improve with repair. Current practice favors a laparoscopic approach, complete sac excision, primary crural repair with or without use of mesh, and a routine fundoplication.
Department of Surgery, Brigham and Women's Hospital, Boston VA Health Care System , Boston, MA , USA ; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston VA Health Care System , Boston, MA , USA.
Abraham
A
Lebenthal
Department of General Surgery, Massachusetts General Hospital , Boston, MA , USA.
Stephen D
SD
Waterford
Department of Surgery, Brigham and Women's Hospital, Boston VA Health Care System , Boston, MA , USA.
P Marco
PM
Fisichella
gastroesophageal reflux disease; hiatal hernias; iron-deficiency anemia; mesh repair; paraesophageal hernias