A simple physiological repair of diaphragmatic hernia: Repositioning of the lower esophageal sphincter.

Simple repositioning of the lower esophageal sphincter (LES) is an effective method of correcting reflux associated with hiatal hernia. Only gastric wall without fundoplication is utilized for placement of repair sutures. Twenty-six patients were studied before and after surgery. Studies included standard history, measurement of LES pressure, testing for reflux, and acid clearing. Preoperatively 73 per cent of patients had classic symptoms of reflux esophagitis; the remainder had other symptoms. After the operation all patients were in markedly improved condition, with 77 per cent reporting complete cessation of symptoms. Seventeen patients had low LES pressure (less than 10 mm. Hg). In this group, the mean preoperative pressure of 6.8 mm. Hg rose to 13.2 mm. Hg after the operation (p