Hiatal hernia--manometric and symptomatic assessment of failed surgical management in 60 patients.

The recurrent symptoms in 60 patients who had undergone surgical management of hiatal hernia with reflux were analysed with the help of manometry. Despite reduction of the hernia in 43 patients, the primary and important defect of sphincter incompetence was the commonest residual abnormality. Oesophageal spasm associated with reflux or occurring as a primary condition was another cause of recurrent symptoms. The addition of vagotomy and pyloroplasty to the hiatal hernia repair procedure in several patients did not prevent reflux. The use of valvuloplasty techniques such as the Hill posterior gastropexy, the Belsey Mark IV operation or the Nissen fundoplication should be encouraged when the primary defect is incompetence of the lower oesophageal sphincter.