{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:49:03Z","timestamp":1778201343943,"version":"3.51.4"},"reference-count":22,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2020,1,12]],"date-time":"2020-01-12T00:00:00Z","timestamp":1578787200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,1,12]],"date-time":"2020-01-12T00:00:00Z","timestamp":1578787200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["UEG Journal"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Accurate information on the natural course of giant paraesophageal hernia is scarce, challenging therapeutic decisions whether or not to operate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>We aimed to investigate the long\u2010term outcomes, including hernia\u2010related deaths and complications (e.g. volvulus, gastrointestinal bleeding, strangulation) of patients with giant paraesophageal hernia that were conservatively managed, and to determine factors associated with clinical outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analysed charts of patients diagnosed with giant paraesophageal hernia between January 1990 and August 2019, collected from a university hospital in The Netherlands. Included patients were subdivided into three groups based on primary therapeutic decision at diagnosis. Radiological, clinical and surgical characteristics, along with long\u2010term outcomes at most recent follow\u2010up, were collected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 293 patients (91\u00a0men, mean age 70.3\u2009\u00b1\u200912.4 years) with a mean duration of follow\u2010up of 64.0\u2009\u00b1\u200958.8\u00a0months. Of the 186 patients that were conservatively treated, a total hernia\u2010related mortality of 1.6% was observed. Hernia\u2010related complications, varying from uncomplicated volvulus to strangulation, occurred in 8.1% of patients. Only 1.1% of patients included in this study required emergency surgery. Logistic regression analysis revealed the presence of symptoms (odds ratio (OR) 4.4, 95% confidence interval (CI) 1.8\u201320.6), in particular obstructive symptoms (vomiting, OR 15.7, 95% CI 4.6\u201353.6; epigastric pain, OR 4.4, 95% CI 1.2\u201315.8 and chest pain, OR 6.1, 95% CI 1.8\u201320.6) to be associated with the occurrence of hernia\u2010related complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Hernia\u2010related death and morbidity is low in conservatively managed patients. The presence of obstructive symptoms was found to be associated with the occurrence of complications during follow\u2010up. Conservative therapy is an appropriate therapeutic strategy for asymptomatic patients.<\/jats:p><\/jats:sec>","DOI":"10.1177\/2050640620953754","type":"journal-article","created":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T07:33:26Z","timestamp":1598254406000},"page":"1163-1173","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":26,"title":["The natural course of giant paraesophageal hernia and long\u2010term outcomes following conservative management"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3678-2019","authenticated-orcid":false,"given":"Renske A B","family":"Oude Nijhuis","sequence":"first","affiliation":[{"name":"Amsterdam UMC University of Amsterdam Gastroenterology Endocrinology Metabolism Meibergdreef 9 Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margot","family":"van der 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Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas J P M","family":"Smout","sequence":"additional","affiliation":[{"name":"Amsterdam UMC University of Amsterdam Gastroenterology Endocrinology Metabolism Meibergdreef 9 Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albert J","family":"Bredenoord","sequence":"additional","affiliation":[{"name":"Amsterdam UMC University of Amsterdam Gastroenterology Endocrinology Metabolism Meibergdreef 9 Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,1,12]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-013-3173-3"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/155335060601300108"},{"key":"e_1_2_14_4_1","first-page":"549","volume-title":"Shackelford\u2019s Surgery of the Alimentary Tract","author":"Hutter 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