MANY patients with hiatus hernia have no esophageal reflux. They do not complain of heartburn or sour eructations. Lying down or bending over is not uncomfortable for them. Their hernias may be large, but they have no esophagitis. Because their symptoms are mild and they may be advanced in years, operation often is not advised.
However, surgical advice differs in this area. For example, in a recent article, Hayward1 states, "Most patients with a paraesophageal hernia have no symptoms and need no treatment." On the other hand, Belsey2 has pointed out,
The mildness of the symptoms belies the risk of this type and the prognosis is poor unless the hernia is reduced. Apart from hemorrhages and perforation of acute peptic ulcers, torsion and gangrene of the stomach may occur at any time. In a series of 22 cases of rolling hernias treated conservatively... on account of the mildness
Gahagan T. Hiatus Hernia Without Esophageal Reflux. Arch Surg. 1967;95(4):595-605. doi:10.1001/archsurg.1967.01330160065008