PARAESOPHAGEAL HIATAL-HERNIA - IS AN ANTIREFLUX PROCEDURE NECESSARY

Between January 1970 and October 1992, 119 patients underwent 126 repa irs of a paraesophageal hiatal hernia at the Lahey Clinic. Seven patie nts with a recurrent hernia required reoperation. Of the procedures, 1 9 (15%) included an antireflux procedure because of severe reflux symp toms and objective evidence of reflux demonstrated by grade 2 esophagi tis on endoscopy, manometric evidence of a hypotensive lower esophagea l sphincter pressure (less-than-or-equal-to 10 mm Hg), positive result s on 24-hour pH monitoring, or all three methods. Follow-up ranged fro m 6 months to 18 years with a median of 61.5 months, and the results o f 115 operations were analyzed. Symptomatic results were good to excel lent after 96 (83.5%) of these 115 operations. Thirteen symptomatic pa raesophageal hernias recurred in 12 patients (one recurrence per 58 pa tient-years of follow-up). Severe reflux symptoms accompanied by endos copic evidence of esophagitis developed in 2 patients who had not unde rgone an antireflux procedure at the time of repair of the hernia. We conclude that an antireflux procedure is rarely required in patients u ndergoing repair of a paraesophageal hiatal hernia and should be emplo yed only when objective evidence of reflux is seen preoperatively.