Iatrogenic hiatal and diaphragmatic hernias

Seven patients with hernias occurring after Belsey hiatal hernia repair are described. These hernias were of two types. Four occurred through the hiatus, had the appearance of a parahiatal hernia, and were attributed to the failure to correct a shortened esophagus. In three patients the hernia occurred through a disrupted counterincision in the diaphragm. In the second group postoperative abdominal distension and possibly technical faults were incriminated. In the first group satisfactory repair was achieved by a Collis-Belsey gastroplasty and an antireflux procedure. In the second group reduction of the hernia and resuture of the diaphragm incision encompassing all layers corrected these life threatening hernias.