What are the guideline sources, guidelines and references for Hiatal hernia ?
Guideline sources The following summarized guidelines for the evaluation and management of hiatal hernia are prepared by our editorial team based on guidelines from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES 2013). 1 Guidelines 1. Classification and risk stratification Classification: Classify hiatal hernias into the following types: Situation Guidance Sliding hernias - the GEJ migrates above the diaphragm, the stomach remains in its usual longitudinal alignment and the fundus remains below the GEJ Type I Pure paraesophageal hernias - the GEJ remains in its normal anatomic position, but a portion of the fundus herniates through the Type II https://web.pathway.md/diseases/recOcTmIRvMcd65LM 1/3 6/24/23, 12:44 PM Hiatal hernia Pathway diaphragmatic hiatus adjacent to the esophagus A combination of types I and II, with both the GEJ and the fundus herniating through the hiatus, and the fundus lies above the GEJ Type III Hiatal hernias with the presence of a structure other than stomach (such as the omentum, colon, or small bowel) within the hernial sac. Type IV 2. Diagnostic investigations Diagnostic strategy: recognize that hiatal hernia can be diagnosed by various modalities. Obtain only investigations that will alter the management. B 3. Surgical interventions Indications for surgery: avoid repairing type I hernias in the absence of reflux disease. D Show 3 more Choice of surgical approach: Perform surgical repair of hiatal hernias by a transabdominal or transthoracic approach, preferring a laparoscopic approach in the majority of cases. B Recognize that a laparoscopic approach is as effective as open transabdominal approach and leads to less perioperative morbidity and shorter hospital stay than an open approach. B Technical considerations for surgery (hernial sac dissection): dissect the hernial sac away from mediastinal structures during paraesophageal hiatal hernia repair B , preferably followed by excision. B Technical considerations for surgery (mesh use): Use a mesh for reinforcement of large hiatal hernia repairs to decrease the risk of short-term recurrence. B Insufficient evidence to recommend either for or against the use of mesh at the hiatus. I Technical considerations for surgery (fundoplication): perform fundoplication during repair of a sliding type hiatal hernia to address reflux. B Show 2 more Technical considerations for surgery (esophageal length): return the GEJ to an infradiaphragmatic position during hiatal hernia repair. B Show 2 more Technical considerations for surgery (gastropexy): https://web.pathway.md/diseases/recOcTmIRvMcd65LM 2/3 6/24/23, 12:44 PM Hiatal hernia Pathway Consider performing gastropexy in addition to hiatal repair. B Consider performing gastropexy alone without hiatal hernia repair as a safe alternative in high- risk patients, recognizing that this approach can lead to high recurrence rates. C Technical considerations for surgery (gastrotomy tube): consider inserting a gastrostomy tube to facilitate postoperative care in selected patients. B 4. Specific circumstances Patients undergoing bariatric surgery: repair any hiatal hernia detected during Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric band placement. B Pediatric patients (indications for surgery): perform surgical repair of symptomatic hiatal hernias in pediatric patients. Consider using a laparoscopic approach. Recognize that the patient's age and size of hernia are not up-front contraindications to laparoscopy. B Pediatric patients (technical considerations for surgery): perform concomitant antireflux procedure for gastroesophageal reflux. B Show 3 more 5. Follow-up and surveillance Postoperative care: do not obtain routine postoperative contrast studies in asymptomatic patients after hiatal hernia repair. D Show 2 more Revisional surgery: consider performing revisional surgery with a laparoscopic approach by experienced surgeons for recurrent hiatal hernia repair. B References 1. Kohn GP, Price RR, DeMeester SR et al. Guidelines for the management of hiatal hernia. Surg Endosc. 2013 Dec;27 12 4409 28. Open 2. Jong Jin Hyun, Young-Tae Bak. Clinical significance of hiatal hernia. Gut Liver. 2011 Sep;5 3 267 77. Open 3. Sabine Roman, Peter J Kahrilas. The diagnosis and management of hiatus hernia. BMJ. 2014 Oct 23;349:g6154. Open 4. Ryan E. Smith, Rai Dilawar Shahjehan. Hiatal Hernia. In: StatPearls Internet]. Treasure Island FL StatPearls Publishing; 2021 Jan. 2020 Sep 1. Open 5. Peter J Kahrilas, Hyon C Kim, John E Pandolfino. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol. 2008;22 4 601 16. Open https://web.pathway.md/diseases/recOcTmIRvMcd65LM 3/3