Siegal Steve R, Dolan James P, Hunter John G
Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail code L223A, Portland, OR, 97239, USA.
Langenbecks Arch Surg. 2017 Dec;402(8):1145-1151. doi: 10.1007/s00423-017-1606-5. Epub 2017 Aug 21.
Hiatal hernias are a common finding on radiographic or endoscopic studies. Hiatal hernias may become symptomatic or, less frequently, can incarcerate or become a volvulus leading to organ ischemia. This review examines latest evidence on the diagnostic workup and management of hiatal hernias.
A literature review of contemporary and latest studies with highest quality of evidence was completed. This information was examined and compiled in review format.
Asymptomatic hiatal and paraesophageal hernias become symptomatic and necessitate repair at a rate of 1% per year. Watchful waiting is appropriate for asymptomatic hernias. Symptomatic hiatal hernias and those with confirmed reflux disease require operative repair with an anti-reflux procedure. Key operative steps include the following: reduction and excision of hernia sac, 3 cm of intraabdominal esophageal length, crural closure with mesh reinforcement, and an anti-reflux procedure. Repairs not amenable to key steps may undergo gastropexy and gastrostomy placement as an alternative procedure.
Hiatal hernias are commonly incidental findings. When hernias become symptomatic or have reflux disease, an operative repair is required. A minimally invasive approach is safe and has improved outcomes.
食管裂孔疝是影像学或内镜检查中常见的发现。食管裂孔疝可能出现症状，或较少见地发生嵌顿或形成肠扭转，导致器官缺血。本综述探讨食管裂孔疝诊断检查和治疗的最新证据。
完成了对具有最高证据质量的当代和最新研究的文献综述。对这些信息进行审查并以综述形式汇编。
无症状的食管裂孔疝和食管旁疝每年有1%的几率出现症状并需要修复。对于无症状的疝，观察等待是合适的。有症状的食管裂孔疝和确诊有反流性疾病的疝需要进行抗反流手术修复。关键手术步骤如下：疝囊的复位和切除、3厘米的腹段食管长度、用补片加强的膈肌脚闭合以及抗反流手术。不适合关键步骤的修复可能采用胃固定术和胃造口术作为替代手术。
食管裂孔疝通常为偶然发现。当疝出现症状或有反流性疾病时，需要进行手术修复。微创方法安全且效果更佳。
