A 58-year-old woman with a large paraoesophageal hiatus hernia containing one third of her stomach is asymptomatic apart from mild postprandial discomfort. Her surgeon advises operative repair even though symptoms are minimal. What is the principal justification for recommending surgery?
- A High lifetime risk of progression to Barrett's oesophagus
- B Increased incidence of oesophageal squamous carcinoma
- C Risk of gastric volvulus with strangulation and necrosis ✓
- D Inevitable development of iron deficiency anaemia
Correct answer: C. Risk of gastric volvulus with strangulation and necrosis
Explanation
True paraoesophageal hernias carry a risk of gastric volvulus, incarceration, strangulation, and gangrene, a potentially fatal complication that can occur without warning, hence elective repair is advised even in minimally symptomatic patients. Reflux and Barrett's oesophagus dominate sliding hiatus hernia, not true paraoesophageal hernias, so option A describes the wrong entity and cannot justify the recommendation here.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.