Failures after surgical treatment of patients with hiatus hernia and reflux symptoms. A pathophysiological study

Patients treated surgically for hiatus hernia and reflux symptoms may still have reflux symptoms at follow-up examination, even though relapse of the hernia cannot be demonstrated on X ray. In an attempt to explain the causes of surgical failures, a group of 13 patients with persisting reflux symptoms after a modified Belsey MK IV repair for sliding hiatus hernia and reflux symptoms underwent intraluminal oesophageal manometry, acid clearing test, and 12-h continuous pH recording in the lower part of the oesophagus. None of the patients had radiological relapse of the hernia. The results of these tests, pre- and post-operatively, were compared with the results obtained in a group of successfully treated patients and with normal subjects. No differences of clinical importance could be demonstrated between the two patient groups with regard to the preoperative test results. Postoperatively, the 'failures' had low sphincter pressure, prolonged acid clearing, and pathological acid reflux. The tests seem of little value in the prediction of symptomatic failures, but do to some extent explain the symptoms of surgical 'failures'.