To the Editor:—
In The Journal of July 29 (177:282, 1961) a question concerned therapy for symptomatic hiatal hernia. Dr. R. E. Braucher concisely described difficulties in diagnosis and outlined nonoperative treatment. His statements, "Only rarely should operation be necessary" and "Surgical treatment should be reserved for complications which cannot be treated medically, such as perforation or strangulation," are, in my opinion, incorrectParaesophageal hernia may be complicated by perforation or strangulation; sliding hiatal hernia is rarely. The sliding hernia is much more common by a ratio of about 20 to 1. Sliding hiatal hernia is protean in its manifestations and complications. Reflux esophagitis and not the size of the hernia is the most frequent basis for the difficulties, and this is usually corrected by operation. One of the most serious complications is a rigid stricture with shortening of the esophagus which presents a most difficult problem in treatment.