Paraesophageal hernia

Paraesophageal hernias account for 5% to 10% of all hiatal hernias. Surgical repair is recommended for paraesophageal hernias, regardless of presenting symptoms, because, if left untreated, approximately one third of patients will present with serious complications such as intrathoracic incarceration of the stomach, bleeding, strangulation, and perforation. Laparoscopic repair of paraesophageal hernias is technically challenging but feasible. Several issues regarding techniques are debated, including the need for sac removal, how to repair the hernia, the need for an esophageal lengthening procedure, and the routine addition of fundoplication.