# Nationwide Survey of the Surgical Treatment for Hiatal Hernia in Japan

## TL;DR

A nationwide study in Japan found that patients with Type I hiatal hernia had better surgical outcomes and different characteristics compared to other hernia types.

## Contribution

The study provides a comprehensive analysis of surgical treatment and outcomes for hiatal hernia types across Japan.

## Key findings

- Type I hernia patients were younger, more male, and had better surgical outcomes like shorter hospital stays.
- Postoperative dysphagia was more common in Types II–IV hernias and linked to preoperative dysphagia and strictures.
- Hernia type was not associated with postoperative recurrence but influenced surgical approach and complications.

## Abstract

This study aimed to clarify patient background characteristics, preoperative findings, surgical factors, and postoperative outcomes according to hernia type in patients who underwent surgery for hiatal hernia in Japan.

We conducted a retrospective, questionnaire‐based clinical review of patients who underwent surgery between January 2001 and December 2015 at institutions with board‐certified esophagologists accredited by the Japan Esophageal Society. Data from 960 cases across 80 institutions in Japan were analyzed.

Of the 960 cases, data on hernia type were available in 838 and included in the analysis. The distribution was as follows: Type I, 524 cases (63%); Type II, 53 (6%); Type III, 171 (20%); and Type IV, 90 (11%). Compared with Types II–IV, Type I patients were younger, more often male, had longer symptom duration, more heartburn, fewer comorbidities, and more severe esophagitis. Strictures were rare, and surgery was more often indicated due to refractoriness to medical treatment. Type I cases had higher rates of laparoscopic surgery and Toupet fundoplication, with shorter operative times, fewer complications, and shorter hospital stays. They had lower rates of postoperative dysphagia. Risk factors for postoperative dysphagia included Types II–IV hernia (OR 1.676, p = 0.002), preoperative dysphagia (OR 1.898, p = 0.006), and esophageal strictures (OR 3.102, p = 0.016). Hernia type was not associated with postoperative recurrence.

Patients with Type I hernia differed from those with Types II–IV in background characteristics, preoperative findings, surgical factors, and postoperative outcomes. Given the higher risk of postoperative dysphagia in Types II–IV, careful attention to surgical technique is warranted.

This nationwide study of 960 hiatal hernia surgeries in Japan found that patients with Type I hernia had distinct characteristics and more favorable surgical outcomes compared to Types II–IV. Postoperative dysphagia was significantly associated with Types II–IV, preoperative dysphagia, and esophageal strictures, highlighting the need for careful surgical planning in these cases.