[The treatment of gastroesophageal reflux using the Kaunitz technic]

The Kaunitz' procedure in the surgical treatment of gastroesophageal reflux associated with a hiatal hernia. In patients with pathological gastroesophageal reflux associated with a hiatal hernia, simple repositioning of the lower esophageal sphincter (L.E.S.) without fundoplication can restore the competence of the L.E.S., provided there is adequate mobilisation of the esophagus and fixation to strong tissues. The procedure proposed by Kaunitz consists of a left thoracotomy, with fixation of the gastroesophageal junction to the diaphragm. In the period May 74-May 83 we performed the procedure on 85 patients. There was no operative mortality and a low early complication rate. All but one patient showed a good repositioning on the postoperative barium swallow and improved dramatically, with complete cessation of reflux symptoms. Seventy-eight patients (92,8%) are followed up regularly by means of a standard questionnaire, barium swallow and esophagoscopy. At this stage of the study, with follow-up periods ranging from 6 months to 9 years, 65 patients (83,3%) show an excellent result, six (7,7%) are greatly improved, with disappearance of the preoperatively existing esophagitis, but keep some mild residual reflux symptoms. In one patient repositioning was impossible. Six recurrences were noted, four of them in patients operated during the early period of our experience with the Kaunitz technique. This simple and effective procedure is a valuable alternative in the surgical treatment of pathological gastroesophageal reflux.