Skip to main content
Thorax logoLink to Thorax
. 1973 May;28(3):379–385. doi: 10.1136/thx.28.3.379

A clinical and radiological review of 204 hiatal hernia operations

E Hoffman 1, M C Sumner 1
PMCID: PMC470045  PMID: 4724505

Abstract

Two hundred and four patients with reflux oesophagitis and hiatal hernia were operated on by a modified Allison's technique and followed up for one to 10 years. To avoid surgical bias, the clinical and radiological findings were assessed by the co-author, a radiologist. Ages, type of hernia, symptoms, coexisting pathology, and operative technique are described. The late follow-up includes an assessment of patients' opinions of their operation and residual symptoms and a review of the radiological findings. The management of 25 patients with fibrous strictures is described. Factors preventing reflux are discussed. Current operative procedures for reflux oesophagitis are reviewed. In this series of 204 cases, five patients, that is 2·5%, were surgical failures. They were all dissatisfied with their operation and their symptoms had not improved; radiologically three of them showed reflux or an irreducible hiatal hernia. This failure rate is not considered unreasonable and the modified Allison's procedure is therefore recommended for patients with reflux oesophagitis.

Full text

PDF
379

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ALLISON P. R. Reflux esophagitis, sliding hiatal hernia, and the anatomy of repair. Surg Gynecol Obstet. 1951 Apr;92(4):419–431. [PubMed] [Google Scholar]
  2. Baue A. E., Hoffer R. E. The effects of experimental hiatal hernia and histamine stimulation on the intrinsic esophageal sphincter. Surg Gynecol Obstet. 1967 Oct;125(4):791–799. [PubMed] [Google Scholar]
  3. Brain R. Peptic strictures of the oesophagus associated with duodenal ulcer and operations for its relief. Proc R Soc Med. 1966 Oct;59(10):929–931. doi: 10.1177/003591576605901002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. CASTEN D. F., BERNHANG A., NACH R. J., SPINZIA J. A physiological basis for the surgical treatment of sliding esophageal hiatal hernia. Surg Gynecol Obstet. 1963 Jul;117:87–93. [PubMed] [Google Scholar]
  5. Clagett O. T. Present concepts regarding the surgical treatment of oesophageal hiatal hernia. Ann R Coll Surg Engl. 1966 Apr;38(4):195–209. [PMC free article] [PubMed] [Google Scholar]
  6. Cohen S., Harris L. D. Does hiatus hernia affect competence of the gastroesophageal sphincter? N Engl J Med. 1971 May 13;284(19):1053–1056. doi: 10.1056/NEJM197105132841902. [DOI] [PubMed] [Google Scholar]
  7. Collis J. L. An appraisal of the methods for treating hiatus hernia and its complications. Ann R Coll Surg Engl. 1970 Jun;46(6):338–349. [PMC free article] [PubMed] [Google Scholar]
  8. EFFLER D. B. ALLISON'S REPAIR OF HIATAL HERNIA: LATE COMPLICATION OF DIAPHRAGMATIC COUNTERINCISION AND TECHNIQUE TO AVOID IT. J Thorac Cardiovasc Surg. 1965 Apr;49:669–676. [PubMed] [Google Scholar]
  9. Ellis F. H., Jr Gastroesophageal reflux. Indications for fundoplication. Surg Clin North Am. 1971 Jun;51(3):575–588. doi: 10.1016/s0039-6109(16)39432-4. [DOI] [PubMed] [Google Scholar]
  10. HIEBERT C. A., BELSEY R. Incompetency of the gastric cardia without radiologic evidence of hiatal hernia. The diagnosis and management of 71 cases. J Thorac Cardiovasc Surg. 1961 Sep;42:352–362. [PubMed] [Google Scholar]
  11. Haddad J. K. Relation of gastroesophageal reflux to yield sphincter pressures. Gastroenterology. 1970 Feb;58(2):175–184. [PubMed] [Google Scholar]
  12. Hill L. D. An effective operation for hiatal hernia: an eight year appraisal. Ann Surg. 1967 Oct;166(4):681–692. doi: 10.1097/00000658-196710000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hoffman E. Strangulated diaphragmatic hernia. Thorax. 1968 Sep;23(5):541–549. doi: 10.1136/thx.23.5.541. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Lind J. F., Warrian W. G., Wankling W. J. Responses of the gastroesophageal junctional zone to increases in abdominal pressure. Can J Surg. 1966 Jan;9(1):32–38. [PubMed] [Google Scholar]
  15. Moffat R. C., Berkas E. M. Bile esophagitis. Arch Surg. 1965 Dec;91(6):963–966. doi: 10.1001/archsurg.1965.01320180097021. [DOI] [PubMed] [Google Scholar]
  16. NISSEN R. Gastropexy and "fundoplication" in surgical treatment of hiatal hernia. Am J Dig Dis. 1961 Oct;6:954–961. doi: 10.1007/BF02231426. [DOI] [PubMed] [Google Scholar]
  17. NISSEN R., ROSSETTI M. SURGERY OF HIATAL AND OTHER DIAPHRAGMATIC HERNIAS. J Int Coll Surg. 1965 Jun;43:663–674. [PubMed] [Google Scholar]
  18. Olsen A. M., Schlegel J. F. Motility disturbances caused by esophagitis. J Thorac Cardiovasc Surg. 1965 Nov;50(5):607–612. [PubMed] [Google Scholar]
  19. Orringer M. B., Skinner D. B., Belsey R. H. Long-term results of the Mark IV operation for hiatal hernia and analyses of recurrences and their treatment. J Thorac Cardiovasc Surg. 1972 Jan;63(1):25–33. [PubMed] [Google Scholar]
  20. Palmer E. D. The hiatus hernia-esophagitis-esophageal stricture complex. Twenty-year prospective study. Am J Med. 1968 Apr;44(4):566–579. doi: 10.1016/0002-9343(68)90057-0. [DOI] [PubMed] [Google Scholar]
  21. Pearson J. B., Gray J. G. Oesophageal hiatus hernia: long-term results of the conventional thoracic operation. Br J Surg. 1967 Jun;54(6):530–533. doi: 10.1002/bjs.1800540607. [DOI] [PubMed] [Google Scholar]
  22. Toye D. K., Williams J. A. Post-gastrectomy bile vomiting. Lancet. 1965 Sep 11;2(7411):524–526. doi: 10.1016/s0140-6736(65)91475-3. [DOI] [PubMed] [Google Scholar]
  23. WINDSOR C. W. GASTRO-OESOPHAGEAL REFLUX AFTER PARTIAL GASTRECTOMY. Br Med J. 1964 Nov 14;2(5419):1233–1234. doi: 10.1136/bmj.2.5419.1233. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES