Paraesophageal hernia: a major complication of Nissen's fundoplication.

Paraesophageal hernia was a major complication in a number of patients who were treated surgically for gastroesophageal reflux by fundoplication. This major complication seems to be predominant in the pediatric age group. The best surgical treatment for gastroesophageal reflux, whether a hiatus hernia is involved or not, is still uncertain. As with many other surgical problems where we must find a compromise, several surgical techniques are adopted. The choice of the surgical approach may depend upon the indications. As the indications for surgery are precise, the results must be reached with the utmost certainty, particularly hen complications already exist (esophagitis, stricture). The results of operative treatment of gastroesophageal reflux are in part, at least, influenced by the considerable tendency to spontaneous improvement, particularly in infants. In most cases, nonoperative treatment is initially undertaken if there are no prior complications. The number of children who are surgically treated depends to a great extent upon the accuracy of this conservative treatment.