The Place of Fundoplication in the Treatment of Hiatal Hernia1

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Abstract
Experiences with Nissen's operation of fundoplication by the abdominal route in the treatment of sliding hiatal hernia with reflux are described. Cadaver studies were carried out, and showed that the fundal cuff encircling the lower arsophagus has a positive valve action preventing reflux. Twenty‐eight fundo plications were performed, and 23 of these were followed for periods ranging from six months to three years. These patients are compared with another group of 25 patients treated by other operations. Fundoplication provided complete control of reflux clinically and radiologically in over 95% of cases, and the results were superior to those of the other operations. The sequela of fundoplication were more acceptable to patients than those of vagotomy and pyloroplasty. It proved an effective and safe addition to the repair of the hiatus, and its use is advocated selectively for patients with severe reflux œsophagitis. Some modifications of the technique of operation are suggested.