Paraesophageal Hiatus Hernia

doi:10.1001/archsurg.1986.01400040052007

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Vol. 121 No. 4, April 1986

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PAPERS READ BEFORE THE 66TH ANNUAL MEETING OF THE NEW ENGLAND SURGICAL SOCIETY, DIXVILLE NOTCH, NH, OCT 11-13, 1985

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Paraesophageal Hiatus Hernia

F. Henry Ellis, Jr, MD, PhD; Robert E. Crozier, MD; John A. Shea, MD

Arch Surg. 1986;121(4):416-420.

Abstract

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

(Arch Surg 1986;121:416-420)

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).

Footnotes

Accepted for publication Jan 3, 1986.

Read before the 66th Annual Meeting of the New England SurgicalSociety, Dixville Notch, NH, Oct 12, 1985.

Reprints not available.

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