Hiatus hernia and reflux esophagitis.

Usually, axial hiatus hernia is a common disorder that produces no symptoms and requires no treatment and in the few patients who do experience symptoms, simple nonoperative treatment measures suffice. The typical symptoms of reflux esophagitis are heartburn and nocturnal regurgitation. Most patients respond well to nonoperative treatment; any associated axial hiatus hernia is not the cause of the symptoms of reflux esophagitis and does not need treatment. In the very few patients who do need an operation, fundoplication conducted through the abdomen is recommended. In nonaxial hiatus hernia the symptoms of intermittent obstruction and bleeding are due to volvulus of the herniated stomach; volvulus produces a closed-loop obstruction, a potentially dangerous condition. Surgical repair should be undertaken when the diagnosis is made, just as for other hernias of the abdominal wall and for the same cogent reasons. Prosthetic reinforced repair conducted through the abdomen is preferred.