Dysphagia complicating hiatal hernia repair.

Dysphagia may be a continuing or added problem after operations for the control of reflux. In a series of 208 patients treated surgically for recurrent hiatal hernia, 34 (16.3%) presented with dominant dysphagia either caused by or aggravated by the operation. They were evaluated by history, radiology, manometry, and endoscopy. The causes of dysphagia were diagnosed in all patients: reflux stricture in nine patients, tight or long Nissen wrap in 15, muscle injury in three, inappropriate myotomy with reflux in three, myotomy with overcompetent repair in two, and early Nissen intussusception in two patients. Surgical correction was by total fundoplication gastroplasty in 32 patients, Nissen repair in one, and colon interposition in one. In four patients the myotomy was closed. Complete follow-up averages 5.4 years. There has been one anatomic recurrence, 28 patients are asymptomatic, and five are much improved but have minor persistent dysphagia. Only by complete investigation can the cause of dysphagia be recognized and treated.