Improvement in results in paraesophageal hernia

Paraesophageal hernias account for between 5 and 14% of hiatal hernias. Surgical management is complex and is currently one of the most debated subjects in surgery. Every symptomatic patient with a paraesophageal hernia and no contraindication for surgery should undergo repair. It is important to perform an evaluation that includes medical history, chest x-rays, barium swallow, upper endoscopy and manometry. Surgical approaches include open thoracic and abdominal access. Recently, laparoscopic surgery has become an option with less morbidity and mortality with results similar to open surgery. Essential technical aspects to improve results are reduction of the hernia sac, recognition and management of the short esophagus, hiatal closure and an antireflux procedure. Despite improving recurrence rates, use of synthetic mesh for hiatal closure has been associated with catastrophic complications; therefore, use of biologic mesh is preferred.