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Which Surgical Procedure for Uncomplicated Hiatus Hernia

Beatty H. Ramsay, MD
JAMA. 1965;192(2):173. doi:10.1001/jama.1965.03080150103036.
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To the Editor:—  One views with alarm the enthusiastic use of vagotomy with pyloroplasty in the treatment of uncomplicated symptomatic hiatus hernia of the esophagus. This is advocated in presentations at surgical and medical meetings, in published papers, and at panel discussions. Some panelists with widespread influence recommend defunctionalizing vagotomy for this entity and either no effort at repair of the hernia or a perfunctory placement of one or two sutures to narrow the hiatus.Surgeons and internists of mature experience know that uncomplicated hiatus hernia, with its usual peptic esophagitis, is cured, unequivocally, by adequate repair of the herniation. Symptomatic relief is immediate. Failure to cure signifies incomplete correction of the herniation. Recurrent herniation is due to technical or tissue failure.Vagotomy bears a long list of significant side effects, including chronic diarrhea (30% among 44 patients undergoing the "balanced" operation for hiatus hernia—Carl Schlicke, Amer J Surg106


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