Indications for Repair of Asymptomatic or Minimally Symptomatic Paraespophageal Hernias: Gastroenterologist’s Perspective on Management

Paraesophageal hernias (PEHs) are a relatively uncommon type of hiatal hernia, thought to comprise only 5% of all hiatal hernias, affecting mainly older adults. Historically, surgical repairs for PEHs were reserved for symptomatic hernias refractory to medical management (i.e., reflux, dysphagia, regurgitation, anemia, dyspnea, or abdominal pain) or complications related to (i.e., bleeding, obstruction, or volvulus). Elective repair in asymptomatic or minimally symptomatic patients remain controversial. Here, we overview the indications and up to date evidence for repair for the asymptomatic and minimally symptomatic PEHs. Our approach is reflective of opinion, based on evidence and our experience, and focused on the following questions regarding PEHs: (1) What is the natural history for untreated PEHs and (2) What is the reported value for surgical repair of PEHs versus observation.