Management of paraesophageal hernias

Paraesophageal hernias are relatively uncommon problems of the esophageal hiatus that deserve specific attention by surgeons and attending medical physicians caring for the patient who has this disorder. The recommendations for management of this problem are dependent upon a variety of patient-related and hernia-related factors. Appreciation of the unique nature of paraesophageal hernias, in contrast to the much more clinically common sliding hiatal hernia, is the first hurdle that must be overcome. To do so, an understanding of the anatomic and pathophysiologic nature of paraesophageal herniation is critical. In this article, the authors delineate the unique clinical characteristics of paraesophageal hernias and review the clinical management arguments of interest today.