E5397. Hiatal Hernia Repair: What the Surgeon Wants to Know From Radiologists
Authors
Mamta Gupta;
Yale University
Robert Kleven;
Yale University
Christopher Gange;
Yale University
Ami Rubinowitz;
Yale University
Babina Gosangi;
Yale University
Daniel Boffa;
Yale University
Leah Traube;
Yale University
Background
Surgeons often rely on radiologists to accurately describe the hernia based on imaging findings. The list of expectations of surgeons from Imaging patient is lengthy, here are some aspects that surgeons typically want to know. Hernia type and classification. Hernia contents: partial or complete hernia or any other herniated contents lying adjacent to the esophagus within the sac. Narrowing or widening of esophageal hiatus. Incarcerated or strangulated tissue within the hernia sac. Anatomy and vasculature: mesh placement and fixation; if there is any dehiscence. Postoperative assessment.
Educational Goals / Teaching Points
Recognize diagnostic appearance of different types of hiatal hernia in quiz format. List and discuss expectations from surgeons from radiologist. Pitfalls.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Radiologist needs to know various indications for the hiatal hernia surgery and some of the Guidelines from Society of American gastroenterological and endoscopic surgeons (SAGES). Repair of a type I hernia in the absence of reflux disease is not necessary. All symptomatic paraesophageal hiatal hernias should be repaired, and patients with acute obstructive symptoms or with volvulus should go for urgent surgery. Routine elective repair of completely asymptomatic paraesophageal hernias may not always be indicated. Surgical consideration depends on patient’s age and comorbidities. Acute gastric volvulus requires reduction of the stomach with limited resection if needed. During operations for Roux-en-Y gastric bypass, sleeve gastrectomy, and the placement of adjustable gastric bands, all detected hiatal hernias should be repaired. A fundoplication must be performed during repair of a sliding type hiatal hernia to address reflux. A fundoplication is also important during paraoesophageal hernia repair.
Conclusion
Collaborating with radiologists allows surgeons to integrate imaging information into their surgical decision-making, leading to more precise and effective treatment outcomes.
