Hiatal Hernia Repair Indications and Considerations
Established Indications for Hiatal Hernia Repair
- The American Gastroenterological Association recommends surgical repair for confirmed pathologic gastroesophageal reflux disease (GERD) with inadequate response to optimized medical therapy 1
- The Society of American Gastrointestinal and Endoscopic Surgeons suggests that candidacy for invasive anti-reflux procedures requires confirmatory evidence of pathologic GERD, exclusion of achalasia, and assessment of esophageal peristaltic function 1
Preoperative Assessment Requirements
- The American College of Gastroenterology recommends high-resolution manometry to assess esophageal peristaltic function and exclude achalasia before considering surgical intervention, although this specific guideline is from Praxis Medical Insights, a similar recommendation is made by 1
- Ambulatory 24-hour pH-impedance monitoring should be considered to determine the mechanism of persistent symptoms and confirm PPI-refractory GERD 1
Special Considerations for Obese Patients
- The American Society for Metabolic and Bariatric Surgery suggests that Roux-en-Y gastric bypass is the preferred primary anti-reflux intervention in obese patients with hiatal hernia, although this specific guideline is from Praxis Medical Insights, a similar warning is made by 1 regarding sleeve gastrectomy
- Sleeve gastrectomy has the potential to worsen GERD and should be avoided in patients with significant reflux symptoms 1