Since about 2% of patients with symptoms warranting an x-ray gastrointestinal study are shown to have some degree of esophageal hernia, it can be assumed safely that the condition is relatively common. Since so few patients come to surgery for this condition, it can be assumed further that esophageal hernia usually is not symptomatic or can be managed by a medical regimen. With these two points in mind it becomes clear that the surgeon must be fairly certain that the patient will be benefited by the operation before it is undertaken. The "nervous" patient is not a candidate for operation unless the condition is severe and accompanied by demonstrable structural changes, such as esophagitis, hemorrhage, volvulus of the stomach, esophageal ulcer, or stricture. The patient with multiple complaints is not a good candidate unless it can be clearly pointed out to the patient just which symptoms are apt to be
BUCHANAN AC, BOWERS WF, SULLIVAN BH. Esophageal Hiatus Hernia: A Problem in Surgical Physiology. AMA Arch Surg. 1957;74(2):276–286. doi:10.1001/archsurg.1957.01280080130021
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