Intraluminal pressure, transmucosal potential difference, and pH studies in the oesophagus of patients before and after Collis repair of a hiatal hernia.

Intraluminal pressure, transmucosal potential difference, and pH studies in the oesophagus of patients before and after Collis repair of a hiatal hernia Intraluminal pressure, transmucosal potential difference, and endo-oesophageal pH measurements were studied in patients with hiatal hernia-before and after a hiatal repair. The operation employed is the Collis (1968) repair for uncomplicated hiatal hernia and does not refer to gastroplasty as recommended for peptic stricture (Collis, 1961). Postoperative studies show that the repair approximates the inferior oesophageal sphincter to the hiatus with the production of a single band of raised pressure at the lower end of the oesophagus. This band is similar to that seen in normal subjects and its appearance was associated with cure of the symptoms, abolition of the gastro-oesophageal reflux, and improvement in the function of the inferior oesophageal sphincter and the musculature of the body of the oesophagus. Certain physiological implications of this study are discussed. One of us (Habibulla, 1972) has described how the high pressure band at the oesophagogastric junction has two parts, one being produced by the crural muscle of the diaphragm and the other by the inferior oesophageal sphincter. These two parts are spread out or separated in patients with hiatal hernia. Intraluminal pressure studies were carried out before and after reduction of the hiatal hernia by Collis (1968) repair. MATERIAL AND METHODS For this investigation 21 patients with simple hiatal hernia were prospectively studied before surgery. The tests were repeated six to 24 months afterwards. All initially had severe reflux symptoms. They have been referred from other hospitals in the area for surgery and in every case the possibility of obtaining relief by medical treatment had proved ineffective. The 21 patients were selected from a group of 31 treated surgically because they had a demonstrable disturbance of the motor function of the oesophagus. All had barium swallow examinations showing free gastro-oesophageal reflux. Oesophagoscopic assessment was made for all patients.