[Problems in the surgical treatment of sliding hiatal hernia (author's transl)]

The aim of surgical treatment of hiatus hernia is well defined: restoration of the esophago-gastric closing mechanism to prevent further reflux of gastric contents and gastric juice into the esophagus. The main problem to realize this demand lies in the variety of discussed closing mechanisms. Interaction of different mechanisms influencing the "anti-reflux barrier" as well as hormonal and neural regulation of the lower esophagus are not yet examined sufficiently enough. Benefits and hazards of several types of operations for repair of hiatal hernia are discussed before the background of the small but slowly growing understanding of the esophago-gastric closing mechanism.