The management of reflux oesophagitis and oesophageal stricture.

In a five year period, 140 patients with hiatal hernia were admitted to the cardiothoracic surgery department for investigation and treatment of their condition. Seventy-three of these patients had oesophageal strictures and of these 35 were treated by oesophageal dilatation and Nissen fundoplication. One patient with an intractable stricture was treated by oesophagogastrectomy. The results of surgery were found to be identical with 47 patients without strictures who underwent Nissen fundoplication. Eighty-three percent of patients were symptom free with normal barium meals five to nine years postoperatively, 11% had only minor reflux or dysphagia and were greatly improved as compared with their preoperative state and 6% suffered significant recurrence of symptoms. Postoperative morbidity was slight and there was no mortality. Thirty-six patients with strictures were treated as outpatients by intermittent bouginage. Eleven patients still attend the department at approximately three monthly intervals.