An approach to the management of para-oesophageal hiatus hernias.

A variety of conservative and surgical options are available in the management of para-oesophageal hiatus hernia. However opinion is divided in regard to the best form of treatment. A series of 71 patients with para-oesophageal hiatus hernia has been studied, to assess hospital management and outcome after treatment. Case notes of all patients were reviewed, and a questionnaire sent to surviving patients. Of those patients treated surgically with an anatomical repair plus a fundoplication, 19% had recurrence of significant symptoms. In contrast, 55% of patients managed by an anatomical repair alone had recurrence of significant symptoms. Conservative management was undertaken in 29 of the 71 patients and 66% had recurrence of significant symptoms, with 13 proceeding to elective surgery. Nevertheless, there is a place for the conservative management of para-oesophageal hernias are usually combined type hernias with associated reflux symptoms and repair of the hernia should include an antireflux procedure.