Which type of hernia is surgically treated due to complications?

Surgical treatment is particularly indicated for paraesophageal hiatal hernias due to the risk of complications, such as strangulation or incarceration. In a paraesophageal hiatal hernia, a portion of the stomach herniates alongside the esophagus into the thoracic cavity. Unlike sliding hiatal hernias, which involve the gastroesophageal junction and are less likely to cause significant complications, paraesophageal hernias can lead to severe outcomes if the herniated stomach becomes trapped and its blood supply is compromised.

The surgical intervention aims to reposition the stomach into the abdominal cavity and reinforce the diaphragm to prevent recurrence. This is essential since untreated, a paraesophageal hiatal hernia can result in life-threatening scenarios due to ischemia.

While other hernias, such as inguinal hernias, can also require surgical intervention if they become incarcerated or strangulated, their primary complication is different compared to the distinct risks associated with paraesophageal hiatal hernias. Sliding hiatal hernias are generally managed conservatively unless they lead to severe symptoms, and umbilical hernias in children often resolve spontaneously and are monitored unless complications arise. Therefore, the urgency and complications associated with paraesophageal hiatal hernias justify their surgical treatment.