Sliding esophageal hiatal hernia and reflux peptic esophagitis

The past two decades have seen outstanding contributions to our knowledge of the physiology of the esophagus, particularly of the lower esophageal sphincter. The clinical syndrome of reflux peptic esophagitis has been clearly delineated and is now well recognized. Although the relationship of the lower esophageal sphincter failure, which causes sliding esophageal hiatal hernia, remains obscure, successful hiatal herniorrhaphy by a variety of methods produces satisfactory clinical results in a majority of patients. There is a significant failure rate in all methods and a morbidity clearly related to operative intervention. Additive surgery such as vagotomy and pyloroplasty is not useful in preventing recurrence and is associated with increased morbidity. Peptic strictures with firm, fibrous stenosis can be satisfactorily treated in most cases with the Thal fundic patch to widen the lumen and Nissen fundoplication to prevent further gastroesophageal reflux.