The incidence of sliding hiatal hernias in patients with gastroesophageal reflux requiring operation.

The incidence of sliding hiatal hernias in 44 patients operated upon for gastroesophageal reflux has been analysed. Preoperative X-ray and endoscopy were carried out in all patients. Esophageal manometry was made in 26 patients and preoperative pH-measurements were made in 22 patients. Sliding hiatal hernia was found by X-ray examination in 24 patients. The incidence of hiatal hernia was increasing with age, while the reflux disease in the non-hiatal hernia patients was equally distributed in different age groups. The low incidence of hiatal hernias, especially in young patients with reflux, implies that the indications for surgery ought to be based on the demonstration of reflux itself, and not on the radiological demonstration of hiatal hernia. The low incidence of radiologic reflux means that X-ray alone never can exclude even severe reflux disease.