Hiatus Hernia

Hiatus hernia is a frequent cause of distressing symptoms. The present attitude to this condition is reviewed on the basis of reports in the literature and a personal series of 224 patients. Oesophagoscopy must be a routine part of investigation. There is a tendency to persevere too long with medical treatment. Hernia repair is a safe procedure even in the elderly and the results are good. Results of repair of para-oesophageal hernia are almost uniformly excellent and this type of hernia should always be treated surgically. Repair of sliding hernia should be advised if a few months of medical treatment fail to relieve symptoms or if oesophagitis is present, and good results can be expected in about 90 per cent of uncomplicated cases. When an oesophageal stricture has developed the results of hernia repair are less good but a good result is still achieved in 70 per cent of patients. A small proportion of patients with fibrous strictures require resection.

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