Management of Emergent, Incarcerated, and Strangulated Paraesophageal Hernia

Abstract

The most dreaded complication of paraesophageal hernia is gastric volvulus with obstruction or strangulation with resultant gastric necrosis. Emergent repair of incarcerated/strangulated paraesophageal hernia has traditionally been performed via an open approach with significant associated morbidity and mortality. In the absence of gastric ischemia, the clinical situation may be temporized with nasogastric or endoscopic decompression/detorsion to allow resuscitation, medical optimization, and transfer to higher level of care. Definitive repair should be offered during the index admission if patient risk factors and facility resources allow. Minimally invasive transabdominal approaches (laparoscopic or robotic) are effective in most cases and should be the primary approach taken.