All the following statements about paraesophageal hernia are true EXCEPT
|A||it can be life-threatening|
|B||heartburn is the usual chief complaint of affected persons|
|C||symptoms can stem from obstruction and hemorrhage|
|D||the herniated portion of the stomach may become gangrenous and perforate|
a. When radiographic examinations are done in response to gastrointestinal symptoms, the incidence of a sliding hiatal hernia is seven times higher than that of a paraesophageal hernia.
b. The age distribution of patients with paraesophageal hernias is significantly different from that observed in sliding hiatal hernias.
c. The median age of the former is 61; of the latter, 48. Paraesophageal hernias are more likely to occur in women by a ratio of 4:1.
d. A paraesophageal hernia rather than a sliding hernia develops when there is a defect, perhaps congenital, in the esophageal hiatus anterior to the esophagus.
e. The persistent posterior fixation of the cardia to the preaortic fascia and the median arcuate ligament is the only essential difference between a sliding and a paraesophageal hernia.
f. There is usually a higher prevalence of symptoms of dysphagia and postprandial fullness with paraesophageal hernias, but the typical symptoms of heartburn and regurgitation present in sliding hiatal hernias can also occur.
g. Approximately one third of patients with a paraesophageal hernia are found to be anemic, which is due to recurrent bleeding from ulceration of the gastric mucosa in the herniated portion of the stomach.
h. With time the stomach migrates into the chest and can cause intermittent obstruction due to the rotation that has occurred.
i. However, the presence of a paraesophageal hernia can be life-threatening in that the hernia can lead to sudden catastrophic events, such as excessive bleeding or volvulus with acute gastric obstruction or infarction.
j. With mild dilatation of the stomach, the gastric blood supply can be markedly reduced, causing gastric ischemia, ulceration, perforation, and sepsis.
k. Physiologic testing with 24-hour esophageal pH monitoring has shown increased esophageal exposure to acid gastric juice in 60% of the patients with a paraesophageal hiatal hernia, compared with the observed 71% incidence in patients with a sliding hiatal hernia.
l. The surgical approach to repair of a paraesophageal hiatal hernia may be either transabdominal (laparoscopic or open) or transthoracic.