[Recurrence of hiatal hernia. A study of 20 cases]

After surgical correction, hiatus hernia recurs in 5--15%. Papers dealing with these recurrences are rare. Among 140 hiatus hernias operated in our service, quite a few had some residual symptoms such as intermittent dysphagia, epigastric pain and flatulence. Three of them had to be reoperated on for a recurrence. In this paper 20 patients operated for recurrent hiatus hernia are reviewed. Some factors predispose to recurrence: inadequate initial operation, stage 3--4 oesophagitis, kyphosis, very broad hiatal orifice at initial operation. When the cases reoperated upon are reviewed some of them are not improved. Most of these patients have psychosomatic problems or are under psychiatric treatment. This is why a patient coming for a recurrent hiatus hernia should be investigated thoroughly. Psychosomatic cases are as bad an indication for a second operation as they probably were for the first one. When reoperation has been decided, several procedures can be used. The choice depends on what was done at the first operation, on the radiological, endoscopic and peroperative findings. In the majority of the cases, an abdominal approach can be used, but occasionally a thoracic or thoraco-abdominal route is preferable. Associated vagotomy does not improve the results and adds its own morbidity.