Do all paraesophageal hernias require surgical intervention?

The correct assertion is that surgical intervention is necessary for all paraesophageal hernias as a preventive measure against complications, including incarceration and strangulation. Paraesophageal hernias occur when part of the stomach pushes up through the diaphragm next to the esophagus, and this condition can lead to significant problems.

In asymptomatic cases, monitoring may seem reasonable initially; however, these hernias have the potential to become symptomatic or lead to acute complications at any time. Unlike sliding hiatal hernias, where the esophagus and stomach maintain their positions during normal activities, paraesophageal hernias can cause the stomach to become trapped and lose its blood supply, leading to incarceration and strangulation. Surgical correction is critical to avoid these life-threatening scenarios and to ensure long-term health.

The notion that only symptomatic cases need intervention overlooks the inherent risks associated with paraesophageal hernias, while guidelines often recommend surgical evaluation and repair even for asymptomatic patients, especially in those who may have factors increasing the risk of complications. Monitoring is typically suggested for smaller, uncomplicated hernias but is not sufficient for managing the underlying risks associated with paraesophageal hernias when they are present.