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Ann Thorac Surg 1979;28:587-593
© 1979 The Society of Thoracic Surgeons

Articles

Nissen Hiatal Hernia Repair: Problems of Recurrence and Continued Symptoms

R.D. Henderson, M.B.*

From the Department of Surgery, University of Toronto, and Women's College Hospital, Toronto, Ont, Canada.

* Address reprint requests to Dr. Henderson, Women's College Hospital, 76 Grenville St, Toronto, Ont, Canada M5S 1B2.

The standard Nissen operation is the most effective method of reflux control. However, the procedure can result in continuance of symptoms, particularly dysphagia, which presents considerable diagnostic difficulty. Experience gained in the management of 17 patients with continued recurrent symptoms following standard Nissen repair has allowed more specific definition of the nature of these problems. The anatomical defect has been categorized as follows: (1) tight repair (tight fundoplication or tight diaphragmatic repair); (2) anatomical recurrence with and without reflux; and (3) intussusception recurrence.

Each patient has been evaluated by history, manometry, pH reflux, acid perfusion, radiology, and endoscopy. At the time of corrective operation, the previous repair was carefully dissected to allow confirmation of the type of defect. Correlation is made between symptoms, investigative findings, and the anatomical problem at operation.




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 Ann. Thorac. Surg.Home page
J. D. Cooper and K. N. Jeejeebhoy
Gastroesophageal Reflux: Medical and Surgical Management
Ann. Thorac. Surg., June 1, 1981; 31(6): 577 - 593.
[Abstract] [PDF]


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