ESOPHAGEAL AND CARDIA FUNCTION IN PATIENTS WITH PARAESOPHAGEAL HIATUS-HERNIA

Background The decision to add an antireflux procedure when a paraoeso phageal hernia is repaired is still controversial. The aim of this stu dy was to investigate oesophageal and cardia function in these patient s to verify whether fundoplication was needed. Methods Eighteen patien ts with paraoesophageal hernia were evaluated by oesophageal manometry , 24-h pH monitoring, endoscopy and barium swallow. All patients under went surgery including antireflux fundoplication. Fourteen patients wi th sliding hernia plus reflux disease and 16 healthy volunteers formed the control groups. Results Patients with paraoesophageal hernia had a shorter lower oesophageal sphincter and a greater acid exposure than healthy controls (P < 0.05). Fifteen of 18 patients had either abnorm al acid exposure and/or a defective lower oesophageal sphincter at man ometry. Postfundoplication symptoms were observed in only one of 16 pa tients at 6 months' follow-up. Conclusion Since 15 of 18 patients had abnormal acid exposure or were considered prone to developing gastro-o esophageal reflux disease because of a defective lower oesophageal sph incter, this study strongly supports the need to add an antireflux ope ration to hernia repair.