Hiatal hernia repair

128 patients operated on for hiatal hernia are reported. The follow-up study consisted of 102 patients, 16 with paraoesophageal and 86 with axial hiatal hernia. The mean follow-up time was 4 1/2 years, range 1-11 years. In our experience cineradiographic studies bring abnormalities to light more readily because this kind of study is repeatable compared with conventional techniques based on fluoroscopy. Four different methods of operation were used in this study. The recurrence rate was as follows: Nissen fundoplication 13%, both anterior 180 degrees fundoplication and Lortat-Jacobs procedure 38%, and Nissen fundoplication combined to vagotomy and pyloroplasty 54%. Postoperative complications occurred in 9%. There was no hospital mortality. The authors prefer the abdominal to the transthoracic approach because many patients had other intra-abdominal, surgically easily correctable condition. If the transthoracic operation is indicated, as in a very obese patient or in a patient with a secondary short oesophagus, intra-abdominal disease must have been excluded preoperatively. In the treatment of axial hiatal hernia the best operative method has not yet been agreed upon, but in our hands the Nissen fundoplication yielded the best results.