Progress in the surgical management of hiatal hernia

A median arcuate repair which anchors the gastroesophageal junction posteriorly has been used in 559 patients operated on for primary hiatal hernia. With 95% follow‐up, there have been 5 (0.89%) recurrences and 2 (0.35%) deaths. Since the introduction of intraoperative manometrics, there have been no recurrences in the last 120 patients operated on for hiatal hernia. A study of the first 126 patients operated on with the use of intraoperative manometry indicates that sphincter competence was restored. The operation, used by surgeons other than the author with equal success when done properly, offers a surgical option for relief of hiatal hernia in those cases when medical treatment has failed or is contraindicated.