A 70-year-old man is incidentally found to have a type II (paraesophageal) hiatal hernia on CT done for renal colic. He has no dysphagia, no reflux symptoms, and no anemia. He is otherwise medically fit. What is the recommended management?
- A PPI therapy and annual endoscopy surveillance
- B Observation with lifestyle modifications
- C Laparoscopic hernia repair with mesh cruroplasty and fundoplication ✓
- D Endoscopic surveillance with barium swallow every 2 years
Correct answer: C. Laparoscopic hernia repair with mesh cruroplasty and fundoplication
Explanation
Type II (paraesophageal) hiatal hernias carry a significant risk of strangulation, volvulus, and obstruction even when asymptomatic. Surgical repair is recommended for fit patients regardless of symptoms. This differs from type I (sliding) hernias, which are managed based on GERD symptoms. Observation is inappropriate given the risk of acute complications.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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Written and medically reviewed by the StethoPrep medical team.