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April 1986

Paraesophageal Hiatus Hernia

Author Affiliations

From the Section of Thoracic and Cardiovascular Surgery (Dr Ellis) and the Department of Gastroenterology (Drs Crozier and Shea), Lahey Clinic Medical Center, Burlington, Mass; and the Division of Thoracic and Cardiovascular Surgery, New England Deaconess Hospital, Boston (Dr Ellis).

Arch Surg. 1986;121(4):416-420. doi:10.1001/archsurg.1986.01400040052007

• Fifty-five operations for paraesophageal hiatus hernia were performed at the Lahey Clinic, Burlington, Mass, between January 1970 and October 1985. Pain was present in 35 of 51 patients. Other less common symptoms were anemia and vomiting. Reflux symptoms were rare. Esophageal manometry disclosed a mean lower esophageal sphincter pressure of 18.2 mm Hg and a length of 3.5 cm. An anterior crural repair (Collis procedure) was employed in all patients. In 22 patients Stamm gastrostomies were also performed. In two patients, a Nissen fundoplication was also carried out because of coexisting gastroesophageal reflux. One patient died postoperatively of a pulmonary embolus. Of the patients, 88.4% benefited from the operation. Of the five poor results, four were due to hernial recurrence and only one was due to severe reflux symptoms. Gastroesophageal reflux is rare in patients with paraesophageal hiatus hernia. An antireflux procedure should be added to surgical correction of the anatomic defect only if evidence of a hypotensive lower esophageal sphincter is clearly present preoperatively or intraoperatively. The addition of gastrostomy to the procedure protects against recurrence of hernia.

(Arch Surg 1986;121:416-420)