The Journal of Thoracic and Cardiovascular Surgery, Vol 88, 922-928, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Dysphagia complicating hiatal hernia repair
RD Henderson
Dysphagia may be a continuing or added problem after operations for the
control of reflux. In a series of 208 patients treated surgically for
recurrent hiatal hernia, 34 (16.3%) presented with dominant dysphagia
either caused by or aggravated by the operation. They were evaluated by
history, radiology, manometry, and endoscopy. The causes of dysphagia were
diagnosed in all patients: reflux stricture in nine patients, tight or long
Nissen wrap in 15, muscle injury in three, inappropriate myotomy with
reflux in three, myotomy with overcompetent repair in two, and early Nissen
intussusception in two patients. Surgical correction was by total
fundoplication gastroplasty in 32 patients, Nissen repair in one, and colon
interposition in one. In four patients the myotomy was closed. Complete
follow-up averages 5.4 years. There has been one anatomic recurrence, 28
patients are asymptomatic, and five are much improved but have minor
persistent dysphagia. Only by complete investigation can the cause of
dysphagia be recognized and treated.
