The Sphincter That Is a Sphinx

In an effort to control excessive gastroesophageal reflux and the esophagitis it is believed to engender, surgeons all over the world have been busy repairing hiatus hernias of the sliding (axial, concentric) type. Twenty years ago, operations designed to narrow the hiatus by manipulation of the diaphragmatic crura were immensely popular, particularly the Allison type. The success claimed in the early 1950's for procedures of this nature was fantastic: among 613 patients operated on by three surgeons, there were only 13 failures, including seven deaths and six recurrences.1 These days, the Allison procedure doesn't look so good, and mere narrowing . . .