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Ann Thorac Surg 1993;56:447-452
© 1993 The Society of Thoracic Surgeons

Articles

Paraesophageal hiatal hernia: Is an antireflux procedure necessary?

Warren A. Williamson, MD*,a,b, F. Henry Ellis, MD, PhDa,b, John M. Streitz, MDa,b, David M. Shahian, MDa,b

a Department of Thoracic and Cardiovascular Surgery, Lahey Clinic Medical Center, Burlington USA
b Division of Cardiothoracic Surgery, New England Deaconess Hospital and Harvard Medical School, Boston, Massachusetts USA

* Address reprint requests to Dr Williamson, Department of Tho-acic and Cardiovascular Surgery, Lahey Clinic Medical Center, 41 Mall Rd, Burlington, MA 01805.

Between January 1970 and October 1992, 119 patients underwent 126 repairs of a paraesophageal hiatal hernia at the Lahey Clinic. Seven patients with a recurrent hernia required reoperation. Of the procedures, 19 (15%) included an antireflux procedure because of severe reflux symptoms and objective evidence of reflux demonstrated by grade 2 esophagitis on endoscopy, manometric evidence of a hypotensive lower esophageal sphincter pressure (≤10 mm Hg), positive results on 24-hour pH monitoring, or all three methods. Follow-up ranged from 6 months to 18 years with a median of 61.5 months, and the results of 115 operations were analyzed. Symptomatic results were good to excellent after 96 (83.5%) of these 115 operations. Thirteen symptomatic paracsophageal hernias recurred in 12 patients (one recurrence per 58 patient-years of follow-up). Severe reflux symptoms accompanied by endoscopic evidence of esophagitis developed in 2 patients who had not undergone an antireflux procedure at the time of repair of the hernia. We conclude that an antireflux procedure is rarely required in patients undergoing repair of a paraesophageal hiatal hernia and should be employed only when objective evidence of reflux is seen preoperatively.




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