Which statement regarding type II (paraesophageal rolling) hiatus hernia is correct?
- A The gastroesophageal junction remains in the abdomen and the fundus herniates alongside it
- B Repair is advised even when asymptomatic because of the risk of gastric volvulus and strangulation ✓
- C It is the commonest type of hiatus hernia and is managed primarily with proton pump inhibitors
- D Gastroesophageal reflux is its dominant clinical feature and it rarely produces mechanical symptoms
Correct answer: B. Repair is advised even when asymptomatic because of the risk of gastric volvulus and strangulation
Explanation
In a true paraesophageal hernia the GEJ stays below the diaphragm while the fundus rolls up beside it, so reflux is often absent but mechanical complications dominate. Because gastric volvulus, incarceration, strangulation and bleeding can occur catastrophically, elective repair is recommended even in minimally symptomatic patients. The sliding (type I) hernia is by far the commonest variety and is the one treated mainly with acid suppression.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.