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A retrospective questionnaire-based review analyzed 960 cases from 80 institutions (2001-2015), with 838 cases available for hernia-type analysis. Type I predominated; compared with Types II–IV, Type I showed younger age, male predominance, longer symptoms, more heartburn, fewer comorbidities, more severe esophagitis, and better dysphagia outcomes.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/nationwide-survey-of-the-surgical-treatment-for-hiatal-hernia-in-japan/413525/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/nationwide-survey-of-the-surgical-treatment-for-hiatal-hernia-in-japan/413525.png","ImageObject",300,407,{"name":92,"@type":93},"pixelkiddo","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What study period and data sources were used to assess hiatal hernia surgery outcomes?","Question",{"text":112,"@type":113},"The study used a retrospective, questionnaire-based review of patients operated between January 2001 and December 2015 at institutions with board-certified esophagologists. Data from 960 cases across 80 institutions were analyzed, with 838 cases available for hernia-type analysis.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How did Type I patients differ from Types II–IV in preoperative and background characteristics?",{"text":117,"@type":113},"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.",{"name":119,"@type":110,"acceptedAnswer":120},"Which factors increased the risk of postoperative dysphagia?",{"text":121,"@type":113},"Postoperative dysphagia risk was associated with 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). 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Data from 960 cases across 80 institutions in Japan were analyzed.  \nResults: 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.  \nConclusion: 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.  \n1 | Introduction  \nHiatal hernia is characterized by protrusion of any abdominal structure other than the esophagus into the thoracic cavity through a widening of the hiatus of the diaphragm [1].  \nHistorically, Bowditch was the first to report hiatal hernia in 1853 [2]. Subsequently, in 1926, Akerlund classified esophageal hiatal hernias from the anatomical and radiological perspectives [3], and in 1951, Allison clearly classified them into three types: the sliding type, paraesophageal type, and combined type [4].  \nThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \n© 2025 The Author(s). Annals of Gastroenterological Surgery p","cbCaiaAX2YrHA8Ar","https://ap.wps.com/l/cbCaiaAX2YrHA8Ar","pdf",451160,15,"English","# ABSTRACT\n## Aim\n## Methods\n## Results\n## Conclusion\n# Introduction\n## Hiatal hernia definitions and classification\n## Historical background of surgical treatment","[{\"question\":\"What study period and data sources were used to assess hiatal hernia surgery outcomes?\",\"answer\":\"The study used a retrospective, questionnaire-based review of patients operated between January 2001 and December 2015 at institutions with board-certified esophagologists. Data from 960 cases across 80 institutions were analyzed, with 838 cases available for hernia-type analysis.\"},{\"question\":\"How did Type I patients differ from Types II–IV in preoperative and background characteristics?\",\"answer\":\"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.\"},{\"question\":\"Which factors increased the risk of postoperative dysphagia?\",\"answer\":\"Postoperative dysphagia risk was associated with 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.\"}]","Nationwide Survey of the Surgical Treatment for Hiatal Hernia in Japan | PDF",1790595092,38]