Optimal workup for a hiatal hernia

Hiatal hernias are common and generally correlated with obesity and increasing age. However, many individuals have no symptoms and are never diagnosed, thus it’s hard to establish the real prevalence of hiatal hernias. To pursue a diagnosis of hiatal hernia is not necessary in asymptomatic patients, but symptomatic ones need evaluation and should be considered for surgical repair. The clinical workup is based on the patient's symptomatology and clinical presentation. For elective HH repair we advocate the use of few standard pre-operative tests as first line. More specific functional and morphological studies scan should be used case by case depending on the hernia size, patients’ symptoms and setting.