[Reoperation for para-esophageal hiatal hernia following fundus plication]

A paraesophageal hiatus hernia was found in 15 of 86 patients examined radiologically due to symptoms after fundoplication (Nissen-Rosetti). 7 patients were reoperated 4 months to 12 years after fundoplication. Hernia repair was achieved by narrowing of the hiatus with sutures (4), attachment of the left lobe of the liver (1) or a Gore-tex patch (1). Additional surgical measures were fundophrenicopexy (4) and ventral corpopexy (4). At follow-up 2-19 years later, 4 of 5 patients had symptomatic improvement but none was symptom free. On x-ray 2 patients had recurrent paraesophageal hernias and 1 patient a slipped fundoplication. We conclude that reoperation for paraesophageal hiatus hernia after fundoplication, with the attendant technical difficulties, is only indicated if severe symptoms are present.