The physiology of dyspnoea associated with giant hiatus hernia has not been well understood; however, it is generally considered a contraindication for surgery.
Recent studies into mechanisms and prevalence of dyspnoea are discussed.
Recent studies suggest that dyspnoea is present in 80% of cases of massive hiatus hernia. Cardiac compression from massive hiatus hernia is a known contributor to dyspnoea in this patient group, as well as pulmonary aspiration.
Paradoxically, dyspnoea could be considered as an indication for surgery in patients presenting with giant hiatus hernia, once the mechanism is established.
Dyspnoea in the presence of a substantially large hiatus hernia has long been considered unrelated and a contraindication to surgery. We present the results of varied studies that suggest dyspnoea, when the mechanism is established, is in fact an indication for surgery in giant hiatus hernia.