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March 1966

Treatment of Hiatus Hernia and Peptic Esophagitis Through Abdominal Approach

Author Affiliations

From the departments of surgery and x-ray, Rothschild Hadassah University Hospital, Jerusalem.

Arch Surg. 1966;92(3):349-353. doi:10.1001/archsurg.1966.01320210029005

THE SLIDING type of hiatus hernia is usually an acquired condition, probably related to congenital weakness of the surrounding structures. The esophagus often appears to be short, but stretches to its normal length as the hernia is reduced at operation. Only in a very small percentage of patients is there actually a congenital shortening of the esophagus.1

As the cardiac end of the stomach passes through the enlarged esophageal hiatus, the cardiac sphincter mechanism is often impaired and gastric juice regurgitates into the esophagus. Since the esophageal mucosa has poor resistance to the pepsin-hydrochloric acid component of the gastric juice, erosion, ulceration, hemorrhage and, finally, stricture with fibrosis and a short esophagus may ensue.2

The relationship between increased gastric hydrochloric acid secretion and symptomatic hiatal hernia was well demonstrated by Casten.3 It is accepted that the presence of a sliding esophageal hiatus hernia is not necessarily associated