Surgical treatment of hiatal hernia: a 10-year survey

Abstract

The results of surgical treatment of 150 patients with hiatal hernia in the decade 1952-62 are presented. They were followed from three to 13 years after herniorrhaphy. All 131 patients alive were interviewed or communicated with. Fifty-one per cent had had a previous abdominal operation. It is concluded that oesophagoscopy is essential to confirm the diagnosis and exclude the presence of oesophagitis, stricture, or neoplasm before beginning any treatment, be it medical or surgical. Anti-obesity measures are advisable before operative treatment. A left transthoracic, Allison type of repair gives excellent results in over 80% of patients, with relief of all symptoms. An anchoring suture between the under surface of the diaphragm and the fundus of the stomach does not improve the results of this type of repair. There is an occasional place for an abdominal or right-sided approach if other right-sided lesions require surgical correction. After a successful operation patients must continue to limit the quantity of food they eat to keep their weight down to a normal level. Two patients are briefly described whose symptoms, due to severe oesophagitis, developed following prolonged nasogastric intubation. A third report describes an unusual post-operative complication of perforation of a Richter-type of hernia of the stomach into the left pleural cavity eight months after hiatal herniorrhaphy.