[Paraesophageal hiatal hernia--risks and surgical indications].

During a 25-year period, 40 patients with paraoesophageal hiatus hernia were operated on by narrowing of the hiatus and gastropexy. The main symptoms were: epigastric pain (40%), reflux symptoms (25%), cardiac symptoms (20%), dysphagia (20%) and dyspnea (8%). Six patients were free of symptoms. Anaemia was present in 33%, gastric ulcer in 15%. Six patients (18%) had to be operated on as emergencies because of gastric ulcer complications in 4 (3 perforations, 1 severe bleeding) and incarceration in 2 patients. Considering the important risk of acute complications in paraoesophageal hernia an elective gastropexy seems generally advisible--also in patients with few or no symptoms, provided there are no contraindications.