Hiatal Hernia Repair

Abstract

The history of surgery for hiatal hernia and gastroesophageal reflux disease (GERD) has paralleled our gradual understanding of the physiological features of the esophagus. The association between GERD and esophagitis was not established until the 1940s, and much controversy arose concerning the relationship between hiatal hernia and GERD. Initial attempts at simply reducing the hernia by closing the crura proved to have unacceptably high failure rates. The Allison repair, introduced in 1951, involved mobilization of the distal esophagus with placement of the gastroesophageal junction within the abdomen and repair of the crura. This operation had a high recurrence rate, and subsequently several attempts were made at both fixing the gastroesophageal junction within the abdomen and wrapping the gastric fundus around the distal esophagus (fundoplication) to create an antireflux valve (1).