Late results in transthoracic herniotomies.

The late results after surgical treatment of hiatus hernia are scarcely commented upon in the literature, and most re-examinations do not state if radiological examinations have been performed on all the patients during the period of follow-up. We find this to be indispensable. The purpose of this investigation has been to assess the late results in a group of patients suffering from hiatus hernia, all of whom were treated surgically and re-examined both clinically and radiologically. Our indications for surgery in hiatus hernia do not differ from those usually stated in the literature. According to the latest contributions the congenital sliding hernia should be treated surgically as early as possible, before oesophagitis and shrinkage of the oesophagus make the reduction of the hernia difficult or impossible (Allison, 1948; Husfeldt, Thomsen, and Wamberg, 1951). The acquired sliding hernia does not need surgical treatment 'when it is small and only causes moderate symptoms. This group can be treated successfully with a bland diet, alkalis, antispasmodics, and postural measures, but herniotomy is indicated in those patients in whom the symptoms are progressing and who do not respond to medical treatment. Increasing size of the hernia, severe bleedings, and incarceration are also indications for operative treatment. The para-oesophageal hernia should, when causing pain, be operated upon because there is a danger of incarceration. The surgical repair of hiatus hernia may either be performed by a thoracic or by an abdominal approach. Although Harrington (1948) advocates the latter method, most surgeons prefer the thoracic route (Sweet, 1948; Husfeldt and others, 1951; Soutter, 1947; Nuboer, 1949). The thoracic approach has the following advantages. The hernial sac, the oesophageal hiatus, and the cardia lie under direct vision and any adhesions may easily be freed. The oesophagus can when necessary be released right up to the aortic arch, and hence the cardia can be brought down below the diaphragm, even in cases where the cardia is found to lie well above the hiatus. In case of difficulties in reducing the hernia, a separate incision may be made in the diaphragm. MATERIAL