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July 1964

Utilization of Inlying pH Probe for Evaluation of Acid-Peptic Diathesis

Author Affiliations

Present address: Department of Surgery, Creighton College of Medicine, Omaha (Dr. Miller); Mount Sinai Hospital, Minneapolis (Dr. DoVale, T. Gunther).

Arch Surg. 1964;89(1):199-203. doi:10.1001/archsurg.1964.01320010201021

This treatise will present data supporting substitution of physiological for anatomical dictums in the management of hiatal hernias. The need for such logic has been supported by the relatively recent demonstration from a number of centers of inordinately high recurrence rates following a deluge of the literature with operations modeled after the pure anatomical techniques presented by Allison in 1951.1

Diagnosis is, of course, of the first order of magnitude, but after having established the presence of an anatomical defect, the important question that then arises is, "Is surgery indicated?" In an asymptomatic group, over the age of forty years, radiologists have estimated that they can demonstrate hiatal hernias in as many as 10%. Furthermore, Eyring reported that 43% of the patients he studied with demonstrable hiatal hernias were asymptomatic.2 It would appear obvious from such statistics that diagnosis by radiologic techniques alone is not an indication for

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