Repair of Paraesophageal Hernia

  • Abraham J. MatarEmail author
  • Edward Lin


The management of paraesophageal hernia (PEH) remains a widely debated topic in gastrointestinal surgery. This is primarily due to a lack of consensus regarding indications for repair and standard operative approaches. Understanding the pathophysiology and anatomy of PEH is crucial to early identification of patient symptoms and preventing late complications, albeit rare. Diagnostic studies, such as endoscopy and upper gastrointestinal (UGI) contrast series, allow the surgeon to make a definitive diagnosis and provide useful anatomical information prior to surgery. Regarding surgical management, there are several core tenets of PEH repair agreed upon by all including reduction of the intrathoracic contents to the intra-abdominal location with an adequate esophageal length, excision of the hernia sac, and sufficient closure of the hiatal defect. Recent controversies involving PEH repair include indications for repair, approach to surgery, the use of mesh for hiatal closure, and the need for an antireflux procedure to name a few. Few randomized controlled trials involving PEH repair exist, and even those may provide conflicting data. The goal of this chapter is to provide an overview of the anatomy, pathophysiology, clinical presentation, and indications for PEH repair, and to dissect out some of the controversies involving surgical management of PEH.


Paraesophageal hernia Hiatal hernia Gastroesophageal reflux disease Short esophagus Fundoplication Mesh Recurrence 


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Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2019

Authors and Affiliations

  1. 1.Department of SurgeryEmory University School of Medicine, Emory University HospitalAtlantaUSA
  2. 2.Department of SurgeryEmory University School of MedicineAtlantaUSA

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