Which type of hiatus hernia carries the highest risk of gastric volvulus and strangulation, and therefore warrants elective surgical repair even when asymptomatic?

• A Type I sliding hiatus hernia
• B Type IV hiatus hernia with another organ in the chest
• C Type III mixed hiatus hernia
• D Type II pure paraoesophageal hiatus hernia ✓

Explanation

In a type II paraoesophageal hernia the gastro-oesophageal junction remains fixed below the diaphragm while the gastric fundus herniates beside it. Because the junction stays anchored, the herniated stomach can twist on itself, producing volvulus, strangulation and gangrene, so repair is advised even in asymptomatic patients. Type I sliding hernias are common, rarely strangulate, and are operated on only for refractory reflux symptoms.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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