A simple physiological repair of diaphragmatic hernia. Repositioning of the lower esophageal sphincter

Simple repositioning of the lower esophageal sphincter (LES) is an effective method of correcting reflux associated with hiatal hernia. Only gastric wall without fundoplication is utilized for placement of repair sutures. 26 patients were studied before and after surgery. Studies included standard history, measurement of LES pressure, testing for reflux, and acid clearing. Preoperatively 73% of patients had classic symptoms of reflux esophagitis; the remainder had other symptoms. After the operation all patients were in markedly improved condition, with 77% reporting complete cessation of symptoms. 17 patients had low LES pressure (less than 10 mm Hg). In this group, the mean preoperative pressure of 6.8 mm Hg rose to 13.2 mm Hg after the operation (p<0.001). Reflux was demonstrated in 14 patients preoperatively, but only 1 patient continued to have reflux after surgery. Repositioning of a low pressure LES is associated with a greater rise in LES pressure than that attributable to intra abdominal pressure and is associated with reduction in reflux. There was no rise in LES pressure in patients whose LES was normal at the outset, although the condition of these patients also improved.