Surgical treatment of symptomatic gastroesophageal reflux recurring after hiatal hernia repair.

Experience of 30 cases with reoperation for recurrent symptoms after hiatal hernia repair is reported. The primary operation had been transabdominal in 21 cases (11 simple cruroplasty, 7 Nissen, 3 Hill) and transthoracic in 9 (5 Husfeldt, 4 simple cruroplasty). Stenosis and/or esophageal shortening were present in at least 8 patients at the primary operation. Symptoms recurred within a year in 26 of the 30 patients. A transthoracic approach was used for all reoperations. At the time of reoperation, 14 patients had no reflux complications or had esophagitis only. At follow-up (2-12 years) 13 were symptom-free and 1 was improved: X-ray showed hernia in one case and 3 had positive standard reflux test. Of the 16 patients with severe reflux complications before reoperation, 12 had shortened esophagus, combined with stricture in 6 cases, and 4 had isolated stricture. The results were less satisfactory in this complicated group, though all were postoperatively improved. There was no operative mortality. Initial failure to recognize esophageal shortening and inadequate repair were common causes of recurrent hernia. Symptomatic relief after reoperation was comparable with that after primary repair.