Our Summary

This research paper focuses on a condition called esophagogastric junction outflow obstruction (EGJOO), which can be caused by a variety of factors, including a type of hernia known as a hiatal hernia (HH). The study aims to understand whether a standard treatment for hiatal hernia is also effective for patients who have both HH and EGJOO.

The researchers looked at the medical records of patients who were treated for hiatal hernia between 2016 and 2020. They particularly focused on patients who had a special type of test (high-resolution esophageal manometry, or HREM) before their hernia treatment. This test can show whether a patient has EGJOO.

Out of 63 patients, 13 had EGJOO before their hernia treatment. The researchers found that there were no significant differences between the patients with EGJOO and those without in terms of their symptoms, the results of their HREM tests, or their recovery from hernia treatment.

Just under a quarter of the EGJOO patients still had symptoms after their hernia treatment, but none of them needed further treatment to address a primary motility disorder (a problem with the movement of food through the esophagus).

The researchers concluded that hernia repair alone is usually enough to treat patients with both HH and EGJOO. However, they say that more research is needed to understand the best way to treat patients who still have EGJOO after hernia repair.

FAQs

  1. What is esophagogastric junction outflow obstruction (EGJOO) and how is it related to hiatal hernia?
  2. What is the role of the high-resolution esophageal manometry (HREM) test in diagnosing EGJOO?
  3. According to the research, is hernia repair alone usually sufficient to treat patients with both hiatal hernia and EGJOO?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hiatal hernia repair is to follow post-operative care instructions carefully, including avoiding heavy lifting, eating smaller meals, and avoiding certain foods that may trigger symptoms. It is also important to attend follow-up appointments with your healthcare provider to monitor your recovery and address any concerns.

Suitable For

Patients who are typically recommended for hiatal hernia repair are those who are experiencing symptoms such as heartburn, regurgitation, chest pain, difficulty swallowing, and reflux. These symptoms are often caused by the hernia allowing stomach acid to flow back into the esophagus. Additionally, patients who have complications related to their hiatal hernia, such as Barrett’s esophagus or esophagitis, may also be recommended for surgery.

In the case of patients with esophagogastric junction outflow obstruction (EGJOO), like the ones in the study mentioned above, surgery for hiatal hernia repair may also be recommended if the symptoms of EGJOO are severe enough to warrant intervention. However, as the study suggests, hernia repair alone may be sufficient in many cases to alleviate symptoms related to both conditions.

Ultimately, the decision to recommend hiatal hernia repair surgery will depend on the individual patient’s symptoms, the severity of their condition, and their overall health status. It is important for patients to discuss their symptoms and treatment options with their healthcare provider to determine the most appropriate course of action.

Timeline

Overall timeline of patient experience before and after hiatal hernia repair:

Before hiatal hernia repair:

  1. Patient experiences symptoms such as heartburn, chest pain, difficulty swallowing, and regurgitation.
  2. Patient undergoes diagnostic tests such as endoscopy, barium swallow, and high-resolution esophageal manometry (HREM) to confirm the presence of a hiatal hernia and any associated conditions like esophagogastric junction outflow obstruction (EGJOO).
  3. Treatment options are discussed with the patient, including lifestyle changes, medication, and surgical repair of the hernia.

After hiatal hernia repair:

  1. Patient undergoes surgical repair of the hiatal hernia, which may involve laparoscopic or open surgery.
  2. Recovery period post-surgery, which may include pain management, dietary restrictions, and physical activity limitations.
  3. Follow-up appointments with the surgeon to monitor healing and address any complications.
  4. Some patients may still experience symptoms after hernia repair, which may require further evaluation and treatment.

In conclusion, patients with both hiatal hernia and EGJOO can typically be effectively treated with hernia repair alone. However, ongoing research is needed to determine the best approach for patients who continue to experience symptoms after hernia repair.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hiatal hernia repair include:

  1. What is the specific type of hiatal hernia I have, and how does it affect my symptoms?
  2. Do I also have esophagogastric junction outflow obstruction (EGJOO), and how does this impact my treatment plan?
  3. What tests will be done to diagnose my condition and determine the best course of treatment?
  4. What are the potential risks and complications associated with hiatal hernia repair surgery?
  5. What is the success rate of hernia repair in patients with both HH and EGJOO?
  6. Will I need additional treatments or follow-up care after the hernia repair surgery?
  7. How long is the recovery process after hiatal hernia repair surgery, and what can I expect during this time?
  8. Are there any lifestyle changes or dietary modifications I should make to prevent the recurrence of my hiatal hernia?
  9. How often should I follow up with my doctor after the surgery, and what signs or symptoms should I watch for that may indicate a complication?
  10. Are there any alternative treatments or therapies that may be beneficial for managing my hiatal hernia and EGJOO?

Reference

Authors: DeLong CG, Liu AT, Taylor MD, Lyn-Sue JR, Winder JS, Pauli EM, Haluck RS. Journal: JSLS. 2022 Oct-Dec;26(4):e2022.00051. doi: 10.4293/JSLS.2022.00051. PMID: 36452906