Repair of hiatus hernia by an abdominal semi-fundoplication technique

The results of an anti-reflux operation are reviewed. The procedure is similar to the Belsey Mark IV operation, a semi-fundoplication, but performed via an abdominal approach. Forty-five patients were operated upon between 1971 and 1977, 41 had a sliding hernia and 4 a para-oesophageal hernia. Two patients died during the observation period. The follow-up of the remaining 43 patients includes clinical, radiological and manometric examinations. The length of follow-up averaged 35 months (7--70 months). There were 6 anatomic recurrences or persisting sliding hernia and one recurrence of paraoesophageal hernia. Three of the patients with recurrence had been subjected to parietal cell vagotomy and hernia repair, and one was a primary technical failure with persisting hernia. In 32 technically successful repairs of sliding hernia performed as a primary procedure without concomitant PCV, there was one recurrence. Subjectively, 93% (40/43) of the patients considered the operative result excellent or good. Manometric studies showed a significant rise in the lower oesophageal sphincter pressure, from a median value of 6.5 mmHg preoperatively to 12.5 mmHg postoperatively (p less than 0.05) (median value in normal controls, 15.3 mmHg).