[Clinical significance of hiatal hernia]

A careful clinical investigation of 245 patients with hiatus hernia was performed. (History and physical examination, x-ray tests, oesophago-gastroscopy with biopsies, 3-point-manometry, rapid pull-through manometry with pentagastrintest). Classification of hiatus hernia was performed by x-ray test. (222 axial hiatus hernia, 14 mixed hiatus hernia, 9 paraoesophageal hiatus hernia) 3-point-manometry and rapid pull-through manometry with Pg-test were used to differentiate the function of the cardia. In spite of a strong selection in 84 out of 245 patients examined in our hospital, a sufficient cardia could be seen. 161 cases showed a gastro-oesophageal reflux which has been in accordance with a decompensated reflux disease in 97 patients. Solely in these 97 patients an operative correction of the gastro-oesophageal reflux seemed convenient. 84 patients showed a considerable variability of oesophageal disorders. In a final correlation between endoscopy, manometry and x-ray tests our opinion was confirmed that hiatus hernia must not lead inevitably to an insufficiency of the cardia. In the above investigations it could be shown that any therapeutic proceeding in the treatment of hiatus hernia first needs a careful analysis of the cardiac and oesophageal activity and second requires a careful indication for the surgical treatment of hiatus hernia.