Management of Giant Paraesophageal Hiatal Hernia

For purposes of this survey, assume that you see an elderly female in your clinic who has been diagnosed with a large (>50% of stomach in the chest) type III (esophagogastric junction has migrated into the chest) paraesophageal hernia. The patient has early satiety as well as postprandial chest pain and shortness of breath.

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1. Do you manage patients with paraesophageal hiatal hernia?

2. Do you believe definitive management of the hernia in this patient is appropriate?

3. In your practice, which surgical approach do you prefer?

4. How often in your practice do such patients require an esophageal lengthening procedure?

5. Do you find that closure of the hiatal defect is usually accomplished satisfactorily using native tissues?

6. Do you routinely reinforce the hiatal closure using artificial material?

7. Do you routinely anchor the stomach in the abdomen by performing gastropexy, gastrostomy, or fundoplication?

8. Do you routinely perform a fundoplication to prevent reflux?

9. In what region is your surgical practice based?