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

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Articles

Paraesophageal hiatal hernia: Is an antireflux procedure necessary?

^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.

	Abstract

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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.

	Footnotes

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Presented at the Twenty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 25–27, 1993.

	References

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1. Peurson FG, Cooper JD, Iives R, Todd TRJ, Jamieson WRE. Massive hiatal hernia with incarceration: a report of 53 cases Ann Thorac Surg 1983;35:45-51.[Abstract/Free Full Text]
2. Walther B, DeMeester TR, Lafontaine E, Courtney JV, Little AG, Skinner DB. Effect of paraesophageal hernia on sphincter function and its implication on surgical therapy Am J Surg 1984;147:111-116.[Medline]
3. Ellis Jr FH, Crozier RE, Shea JA. Paraesophageal hiatus hernia Arch Surg 1986;121:416-420.[Medline]
4. Streitz Jr JM, Ellis Jr FH. Iatrogenic paraesophageal hiatus hernia Ann Thorac Surg 1990;50:446-449.[Abstract/Free Full Text]
5. Collis JL, Kelly TD, Wiley AM. Anatomy of the crura of the diaphragm and the surgery of hiatus hernia Thorax 1954;9:175-189.[Free Full Text]
6. Collis JL. Surgical control of reflux in hiatus hernia Am J Surg 1986;115:465-471.
7. Allen MS, Trastek VF, Dechamps C, Pairolero PC. Intrathoracic stomach: presentation and results of operation J Thorac Cardiovasc Surg 1993;105:253-259.[Abstract]
8. Ozdemir IA, Burke WA, Ikins PM. Paraesophageal hernia: a life-threatening disease Ann Thorac Surg 1973;16:547-554.[Abstract/Free Full Text]
9. Menguy R. Surgical management of large paraesophageal hernia with complete intrathoracic stomach World J Surg 1988;12:415-422.[Medline]
10. Landreneau RJ, Johnson JA, Marshall JB, Hazelrigg SR, Boley TM, Curtiss JJ. Clinical spectrum of paraesophageal herniation Dig Dis Sci 1992;37:537-544.[Medline]
11. Wichterman K, Geha AS, Cahow CE, Baue AE. Giant paraesophageal hiatus hernia with intrathoratic stomach and colon: the case for early repair Surgery 1979;86:497-506.[Medline]
12. Hill LD. Incarcerated paraesophageal hernia: a surgical emergency Am J Surg 1973;126:286-291.[Medline]
13. Babb RR, Peck DC, Jamplis RW. Gastric volvulus and obstruction in paraesophageal hiatus hernia: a surgical emergency Am J Dig Dis 1972;17:119-128.[Medline]
14. Shocket E, Neber J, Drosd RE. The acutely obstructed incarcerated paraesophageal hiatal hernia Am J Surg 1964;108:805-810.[Medline]
15. Treacy PJ, Jamieson GG. An approach to the management of para-oesophageal hiatus hernia Aust NZ J Surg 1987;57:813-817.[Medline]
16. Skinner DB, Belsey RH. Surgical management of esophageal reflux and hiatus hernia: long-term results with 1,030 patients J Thorac Cardiovasc Surg 1967;53:33-54.[Medline]
17. Harriss DR, Graham TR, Galea M, Salama FD. Paraoesophageal hiatal hernias: when to operate J R Coll Surg Edinb 1992;37:97-98.[Medline]

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