The Serious Significance of Hiatus Hernia

Until recent years esophageal hiatus hernia has been a very poorly understood disorder that carried a high incidence of serious complications and a disorder for which no satisfactory treatment has been available. Most of the problems, however, regarding this lesion have been solved, and a satisfactory corrective surgical procedure has been developed which gives good results, with a low to insignificant morbidity and mortality rate. Three general varieties of esophageal hiatus hernia are ordinarily recognized—sliding hiatus hernia with redundant esophagus, congenitally short esophagus with intrathoracic stomach, and paraesophageal hiatus hernia (Fig. 1). The sliding variety of hiatus hernia is certainly the commonest and is responsible for the great majority of the serious complications. As pointed out by Sweet in 1952,¹the vast majority of hiatus hernias appear by roentgenographic examination to be associated with a truly short esophagus. In almost every instance, however, it is usually discovered at