Hiatal hernia. A follow-up study.

A series of 68 patients who had been surgically treated for hiatal hernia were followed up and re-studied. Several repair procedures were used, but an antireflux operation was carried out in 80% (49 Nissen-Rossetti fundoplications and 6 Belsey Mark IV repairs). The primary hospital mortality rate was 3%. Late results were evaluated by studying the patients with endoscopy, cineradiography, and intraluminal pH probe. The overall clinical late results were good in 96%, excluding the 3% primary mortality rate. To achieve these results, however, several secondary operations were necessary. Good primary results after antireflux procedures were obtained in 89%. The present surgical principles are: (1) the hernias of the good-risk normoacid patients are repaired with a Belsey Mark IV procedure, (2) the hernias of hyperacidity patients are repaired with transabdominal fundoplication combined with parietal cell vagotomy without drainage and (3) moderate oesophageal strictures with an antireflux procedure followed by periodical oesophageal dilatation. Resection of oesophagus is reserved for advanced strictures only.