A 55-year-old woman has a type III hiatus hernia (paraesophageal hernia) on CT scan with the gastric fundus herniated into the chest. She is asymptomatic. What is the recommended management?
- A Elective surgical repair is recommended regardless of symptoms ✓
- B Annual CT surveillance only
- C Medical management with PPIs indefinitely
- D Emergency surgery given the high risk of strangulation
Correct answer: A. Elective surgical repair is recommended regardless of symptoms
Explanation
Type III (mixed) paraesophageal hernias carry a risk of acute gastric volvulus, incarceration, and strangulation (though the risk of acute life-threatening complications is approximately 1–2%/year, lower than previously thought). Current surgical consensus favours elective laparoscopic repair even in asymptomatic patients because the mortality of emergency surgery for complications (~5–17%) far exceeds elective repair (<0.5%). Annual surveillance is insufficient as deterioration can occur rapidly.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.