腹腔镜食管裂孔疝修补联合胃底折叠术治疗胃食管反流病合并食管裂孔疝

目的：探讨腹腔镜下行食管裂孔疝修补联合胃底折叠术治疗胃食管反流病合并食管裂孔疝的临床疗效和安全性。 方法：回顾性分析2012年1月—2014年2月在我院进行食管裂孔疝修补联合胃底折叠术的58例胃食管反流病合并食管裂孔疝患者临床资料,其中36例在腹腔镜下行食管裂孔疝修补联合胃底折叠术（观察组）,22例患者行开腹手术（对照组）。观察并比较两组患者手术时间、术中出血量、术后住院时间、术后胃肠道功能恢复时间及术后并发症发生情况,手术前及手术后4个月进行反流性疾病问卷（RDQ）调查结果。 结果：观察组手术时间、术后住院时间、术后胃肠道功能恢复时间均明显短于对照组（均P<0.05）;观察组术中出血量及术后并发症发生情况均明显优于对照组（P<0.05）;两组患者RDQ评分显示术后4个月症状均有不同程度的改善,观察组患者症状改善程度优于对照组患者（均P<0.05）。 结论：腹腔镜下行食管裂孔疝修补联合胃底折叠术治疗胃食管反流病合并食管裂孔疝,疗效显著,安全性好,可积极应用于临床上胃食管反流病合并食管裂孔疝的治疗。     

腹腔镜Nissen胃底折叠术对胃食管反流病患者食管动力学的影响

目的通过食管高分辨率测压（high resolution manometry,HRM）对比胃食管反流病（gastroesophageal reflux disease,GERD）患者腹腔镜下Nissen胃底折叠术（laparoscopic Nissen fundoplication,LNF）前后食管动力学的改变情况,探讨手术的抗反流原理。 方法选取2014年6月至2016年7月,火箭军总医院73例连续住院的GERD患者,LNF术前1周内行包括HRM在内一系列术前评估,术后GERD症状明显缓解且吞咽困难等并发症已经消失时复查HRM。对手术前后2次HRM的9个食管动力学参数进行对比分析,并按术前是否存在食管裂孔疝进一步分组分析。 结果术后患者食管长度平均延长了（0.43±1.72）cm,腹腔内下食管括约肌长度平均延长了（1.20± 0.94）cm,术后患者下食管括约肌静息压平均增加了（5.99±7.79）mmHg（1 mmHg=0.133 kPa）,综合松弛压平均增加了（3.41±5.43）mmHg;远端收缩分数平均增加了（157.26±596.01）mmHg·s·cm,远端收缩延迟时间平均增加了（0.93±2.30）s;上述6个动力学参数与术前比较差异均有统计学意义（P=0.04,<0.01,<0.01,<0.01,0.03,<0.01）。而术后下食管括约肌长度、食管上括约肌压力和收缩前沿速度与术前相比差异无统计学意义（P=0.83,0.43,0.73）。食管长度、下食管括约肌长度和远端收缩分数在食管裂孔疝患者中较无食管裂孔疝患者改善更为显著（P<0.01,<0.01,<0.01）。 结论LNF主要通过延长腹腔内食管长度,增强下食管括约压力,增强食管的廓清功能,从而到达有效的抗反流作用。其中合并食管裂孔疝的患者较无食管裂孔疝患者术后上述食管动力学改善更为显著。     

腹腔镜联合胃镜治疗食管裂孔疝合并胃间质瘤的疗效

目的探讨腹腔镜联合胃镜治疗食管裂孔疝合并胃间质瘤（GST）的临床效果。 方法回顾性分析2015年3月至2018年3月，黄石市第二医院接受治疗的22例食管裂孔疝合并GST患者临床资料，所有患者均在腹腔镜联合胃镜下行瘤体切除，后在腹腔镜下行食管裂孔疝修补术和胃底折叠术。 结果所有患者均在腹腔镜联合胃镜下顺利完成手术，无中转开腹病例。平均手术时间（103.1±15.2）min，平均术中出血量（88.7±12.3）ml，平均术后首次肛门排气时间（14.3±3.5）h，平均术后恢复进食时间（1.9±1.1）d，平均住院时间（5.3±1.4）d。术后伤口轻度感染患者1例，其他患者术后均未见胃腔出血、肠管损伤、腹腔感染、食管或胃底溃烂穿孔、食管狭窄等并发症。术后随访10个月，所有患者均未出现复发及远处转移。 结论腹腔镜联合胃镜治疗食管裂孔疝合并GST手术成功率高，术后并发症少，患者恢复较快，值得临床推广。     

腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术治疗食管裂孔疝合并胃食管反流病的临床疗效

目的探讨腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术治疗食管裂孔疝（HH）合并胃食管反流病患者的临床疗效。 方法选择2016年1月至2019年1月河北北方学院附属第二医院收治的108例食管裂孔疝合并胃食管反流病患者开展回顾性研究，按照不同手术方式将患者分为2组，每组患者54例。对照组行常规开腹手术，联合组行腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术，比较2组患者术前及术后6个月反流时间、反流次数、DeMeester评分、食管下括约肌压力及Gerd Q量表评分。 结果2组术前反流时间、反流次数、DeMeester评分、食管下括约肌压力及Gerd Q量表评分比较，差异无统计学意义（P>0.05）；2组患者术后6个月反流症状与术前比较，均得到明显改善，差异有统计学意义（P<0.05）；2组术后反流时间、反流次数、DeMeester评分、食管下括约肌压力及Gerd Q量表评分比较，差异有统计学意义（P<0.05）。联合组患者的手术时间、术中出血量及术后住院时长均明显优于对照组，差异有统计学意义（P<0.05）。 结论腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术对HH合并胃食管反流病患者效果显著，有利于患者身体快速恢复，微创、安全且近期疗效满意。     

地市级医院初期开展腹腔镜下食管裂孔疝修补及胃底折叠术的经验

目的探讨地市级医院初期开展腹腔镜下食管裂孔疝修补及胃底折叠术的技术要点及临床疗效。 方法回顾分析咸阳市中心医院2016年3月至2019年3月,行腹腔镜下食管裂孔疝修补、胃底折叠术31例患者的临床资料。按胃底折叠术的术式不同,分为Dor术式组、Toupet术式组、Nissen术式组。观察并记录各术式组患者的手术时间、术中出血量、住院时间。随访3~36个月时的并发症及复发率。 结果31例均行腹腔镜下食管裂孔疝修补联合胃底折叠术。其中Dor折叠4例、Toupe折叠3例、Nissen折叠24例;各术式手术时间分别为（60±4.5）、（68±6.3）、（70±9.2）min;各术式术中出血量分别为（21±4.8）、（24±5.4）、（30±9.1）ml;术后出院时间（7±2.1）、（8±2.8）、（9±2.4）d。31例患者术后不适症状均得到缓解,4例患者术后出现吞咽困难并发症,其中1例患者因保守对症治疗效果不理想,行二次手术拆除胃底折叠后好转,其余3例患者经对症治疗后缓解。31例患者术后随访,失访患者1例,随访3~36个月,中位时间28个月。经胃镜、上消化道造影检查,未复发且无其他并发症发生。 结论腹腔镜下食管裂孔疝修补、胃底折叠术安全、有效,微创优势明显,值得临床推广。     

腹腔镜治疗食管裂孔疝的临床应用

目的探讨使用腹腔镜行食管裂孔疝修补术的疗效和安全性。方法对26例食管裂孔疝患者使用腹腔镜行食管裂孔疝修补术，其中16例做胃底270。部分折叠术（Toupet术），10例做胃底360°胃底折叠术（Nissen术）。19例应用补片修补疵缺口，7例采用7号丝线缝合。结果26例腹腔镜食管裂孔疝修补术全部获得成功。手术时间30～190min，平均110min，失血10～50ml；术后24～48h进流质饮食，无术后并发症；术后平均住院5．7d。结论26例患者的反酸症状均在24h内缓解，术后停用抗酸药物，修补术具有疗效确定、安全和创伤小的优点。值得进一步推广应用。     

腹腔镜Ⅲ、Ⅳ型食管裂孔疝修补术54例临床分析

目的 分析腹腔镜手术治疗Ⅲ、Ⅳ型食管裂孔疝的方法和疗效。方法 回顾性分析2014年1月至2021年1月东南大学附属中大医院普外科收治的54例行腹腔镜手术治疗的Ⅲ、Ⅳ型食管裂孔疝病人的临床资料，手术方式为食管裂孔疝修补术+胃底折叠术。随访观察术后疗效及并发症发生情况。结果 Ⅲ、Ⅳ型食管裂孔疝54例，包括Ⅲ型食管裂孔疝33例，Ⅳ型21例。手术时间为（166.1±67.2）min，术后中位住院时间为7（4~42）d。无围手术期死亡，中转开放手术2例。所有病人术后症状明显改善。随访46（8~80）个月，无疝复发。结论 对于Ⅲ型和Ⅳ型食管裂孔疝病人，建议早期行腹腔镜食管裂孔疝修补术及胃底折叠术治疗，以减少并发症发生。     

腹腔镜食管裂孔疝修补术并发症的预防

目的探讨使用腹腔镜行食管裂孔疝修补术的疗效和安全性。减少手术并发症,随访腹腔镜治疗食道裂孔疝的效果。方法对280例食管裂孔疝患者使用腹腔镜行食管裂孔疝修补术,其中132例做胃底270°部分折叠术（Toupet术）,148例做胃底360°折叠术（Nissen术）。36例应用补片修补疝缺口,剩余患者采用直接缝合。结果 280例腹腔镜食管裂孔疝修补术全部获得成功。手术时间30～190min,平均手术时间110min,失血10～50ml;术后24～48h进流质饮食,无术后并发症;术后平均住院5.7d。结论腹腔镜食道裂孔疝修补术具有疗效确定、安全和创伤小的优点。并发症率极低。     

腹腔镜疝修补术结合Nissen胃底折叠术治疗胃食管反流合并食管裂孔疝的疗效

目的分析腹腔镜疝修补术结合Nissen胃底折叠术治疗胃食管反流合并食管裂孔疝患者的临床疗效观察。 方法选择内蒙古包钢医院2019年7月至2020年5月就诊的80例胃食管反流合并食管裂孔疝患者,按不同手术方式分为A组和B组,每组患者40例。A组采用腹腔镜疝修补术+Nissen胃底折叠术,B组采用腹腔镜疝修补术+Dor胃底折叠术。比较2组患者手术情况、食管反流情况、食管压力、消化病生存质量指数（GLQI）评分、胃食管反流病疗效评分（GERD-Q）、复发率以及不良反应情况。 结果2组患者手术情况差异均无统计学意义（P>0.05）;术后3个月,反流时间、次数,长反流次数、酸反流时间百分比明显改善,且A组改善幅度更明显（P<0.05）;食管残余压平均值、下段括约肌压力、松弛率和无效吞咽率均明显改善,且A组改善情况优于B组（P<0.05）;2组患者GLQI与GERD-Q评分均有所改善,且A组GLQI评分高于B组,GERD-Q评分低于B组（P<0.05）;2组不良反应和复发率比较差异无统计学意义（P>0.05）。 结论腹腔镜疝修补术联合Nissen胃底折叠术对抗反流,减轻术后吞咽困难具有明显效果,有效改善患者生活质量和食管下括约肌压力安全有效。     

高分辨率食管测压技术在腹腔镜治疗食管裂孔疝中的应用

目的探讨高分辨率食管测压（HRM）技术在腹腔镜治疗食管裂孔疝中的作用，为食管裂孔疝的诊断及手术提供临床依据。 方法回顾性分析2016年4月至2018年10月，首都医科大学附属北京朝阳医院行胃镜及HRM检查，确诊为食管裂孔疝并收住疝和壁外科的67例患者的临床资料，计算胃镜及HRM检查食管裂孔疝的确诊率，分析手术情况，总结HRM技术在腹腔镜治疗食管裂孔疝手术中的地位及作用。 结果HRM的检出率80.59%（54/67），特异性为100%（54/54）；胃镜确诊为52.24%（35/67）；其中由胃镜和HRM均确诊35例患者，约占64.81%（35/54），HRM技术的检出率明显高于胃镜；其中48例行腹腔镜治疗食管裂孔疝修补术治疗，7例患者及家属放弃手术选择内科保守治疗，12例合并其他基础疾病，保守或择期手术。 结论HRM技术能够准确、直观的描述食管裂孔疝患者胃食管压力差，确诊率高，能够有效的指导手术方案。     

Hiatal hernia of the esophagus and GERD as a cause of hemorrhage

Bleeding complications arise in 1/4 of patients with hiatal hernia and GERD, and are the cause in 10% of all acute and 1/3 of chronic foregut bleedings. Most common bleeding disorders directly related to hiatal hernia and GERD are: hiatal hernia ulcers, erosive esophagitis, esophageal ulcers, peptic strictures and Barrett esophagus. The aim of this review article is to point out a significance of proper diagnosis and treatment for conditions bonded with hiatal hernia and GERD which can lead to severe esophageal bleedings. Detailed etiology, incidence, diagnostic algorithm and treatment of Cameron lesions, prolapse gastropathy, erosive esophagitis, peptic esophageal ulcers and postoperative complications related to hiatal hernia and GERD are presented in this article.     

Paradigm shift in the management of gastroesophageal reflux disease

OBJECTIVE: To compare the short-term results of the radiofrequency treatment of the gastroesophageal junction known as the Stretta procedure versus laparoscopic fundoplication (LF) in patients with gastroesophageal reflux disease (GERD). SUMMARY BACKGROUND DATA: The Stretta procedure has been shown to be safe, well tolerated, and highly effective in the treatment of GERD. METHODS: All patients presenting to Vanderbilt University Medical Center for surgical evaluation of GERD between August 2000 and March 2002 were prospectively evaluated under an IRB-approved protocol. All patients underwent esophageal motility testing and endoscopy that documented GERD preoperatively, either by a positive 24-hour pH study or biopsy-proven esophagitis. Patients were offered the Stretta procedure if they had documented GERD and did not have a hiatal hernia larger than 2 cm, LES pressure less than 8 mmHg, or Barrett's esophagus. Patients with larger hiatal hernias, LES pressure less than 8 mmHg, or Barrett's were offered LF. All patients were studied pre- and postoperatively with validated GERD-specific quality-of-life questionnaires (QOLRAD) and short-form health surveys (SF-12). Current medication use and satisfaction with the procedure was also obtained. RESULTS: Results are reported as mean +/- SEM. Seventy-five patients (age 49 +/- 14 years, 44% male, 56% female) underwent LF and 65 patients (age 46 +/- 12 years, 42%, 58% female) underwent the Stretta procedure. Preoperative esophageal acid exposure time was higher in the LF group. Preoperative LES pressure was higher in the Stretta group. In the LF group, 41% had large hiatal hernias (>2 cm), 8 patients required Collis gastroplasty, 6 had Barrett's esophagus, and 10 had undergone previous fundoplication. At 6 months, the QOLRAD and SF-12 scores were significantly improved within both groups. There was an equal magnitude of improvement between pre- and postoperative QOLRAD and SF-12 scores between Stretta and LF patients. Fifty-eight percent of Stretta patients were off proton pump inhibitors, and an additional 31% had reduced their dose significantly; 97% of LF patients were off PPIs. Twenty-two Stretta patients returned for 24-hour pH testing at a mean of 7.2 +/- 0.5 months, and there was a significant reduction in esophageal acid exposure time. Both groups were highly satisfied with their procedure. CONCLUSIONS: The addition of a less invasive, endoscopic treatment for GERD to the surgical algorithm has allowed the authors to stratify the management of GERD patients to treatment with either Stretta or LF according to size of hiatal hernia, LES pressure, Barrett's esophagus, and significant pulmonary symptoms. Patients undergoing Stretta are highly satisfied and have improved GERD symptoms and quality of life comparable to LF. The Stretta procedure is an effective alternative to LF in well-selected patients.     

快速康复外科理念对行食管裂孔疝修补联合胃底折叠术患者的护理效果

目的探讨快速康复外科（fast track surgery,FTS）理念对行食管裂孔疝修补联合胃底折叠术患者的护理效果。 方法选取2017年2月至2018年5月,吉林大学第二医院收治的52例食管裂孔疝患者为研究对象,随机分为研究组与对照组,每组患者26例。2组均行食管裂孔疝修补联合胃底折叠术,对照组给予围手术期常规干预,研究组给予FTS理念的系统干预,术后均随访3个月。比较2组术后胃肠道功能恢复时间、急性疼痛、并发症及应激反应方面的差异。 结果研究组术后肠鸣音恢复时间、首次肛门排气时间、胃管拔除时间、进食时间及住院费用较对照组缩短/降低,差异均有统计学意义（P均<0.05）。术后第2天研究组和对照组平均NRS评分分别为（3.05±1.32）、（4.13±1.42）分;与对照组比较,研究组术后第2天NRS评分降低,且疼痛程度明显减轻,差异有统计学意义（P<0.05）。术后随访期间研究组恶心、呕吐、便秘及尿潴留发生率均低于对照组,差异均有统计学意义（P均<0.05）。 结论FTS理念的系统干预可促进行食管裂孔疝修补联合胃底折叠术的食管裂孔疝患者胃肠功能恢复,减轻患者疼痛程度,降低术后并发症的发生率。     

The role of esophageal motility and hiatal hernia in esophageal exposure to acid

Background: The pathogenesis of gastroesophageal reflux disease (GERD) is multifactorial. This study evaluates the relationship between esophageal exposure to acid, the presence or absence of a hiatal hernia, and manometric indicators of esophageal motility. Methods: A total of 51 patients with foregut symptoms were evaluated with upper gastrointestinal series or endoscopy, 24-h pH testing, and esophageal manometry. The DeMeester score was used to distinguish patients with physiologic reflux (DeMeester score <14.72) FROM PATIENTS WITH PATHOLOGIC REFLUX (DEMEESTER SCORE >14.72). Results: Patients with physiologic reflux had fewer hypotensive contractions and a smaller percentage of uncoordinated and hypotensive contractions combined, as compared to patients with pathologic reflux. The amplitude of distal esophageal contractions was greater in patients with physiologic reflux. Also, patients with a hiatal hernia had a higher incidence of pathologic reflux, regardless of the lower esophageal sphincter pressure. Conclusion: Patients with pathologic reflux have abnormal acid exposure associated with pump failure of the esophagus and/or a mechanical defect of the cardia associated with a hiatal hernia.     

Comparison of upper gastrointestinal series and symptom questionnaires with intraoperative diagnosis of hiatal hernia during sleeve gastrectomy

BackgroundHiatal hernias are common in bariatric surgery patients, but the utility of preoperative hiatal hernia diagnosis prior to sleeve gastrectomy (SG) is debated.ObjectiveThis study compared preoperative and intraoperative hiatal hernia detection rates in patients undergoing laparoscopic SG.SettingUniversity hospital, United States.MethodsAs part of a randomized trial evaluating the role of routine crural inspection during SG, an initial cohort was prospectively studied to assess the correlation between preoperative upper gastrointestinal (UGI) series, reflux and dysphagia symptoms, and intraoperative hiatal hernia diagnosis. Preoperatively, patients completed the Gastroesophageal Reflux Disease Questionnaire (GerdQ), the Brief Esophageal Dysphagia Questionnaire (BEDQ), and a UGI series. Intraoperatively, patients with an anteriorly visible defect underwent hiatal hernia repair followed by SG. All others were randomized to standalone SG or posterior crural inspection with repair of any hiatal hernia identified prior to SG.ResultsBetween November 2019 and June 2020, 100 patients (72 female patients) were enrolled. Preoperative UGI series identified hiatal hernia in 28% (26 of 93) of patients. Intraoperatively, hiatal hernia was diagnosed during initial inspection in 35 patients. Diagnosis was associated with older age, lower body mass index, and Black race but did not correlate with GerdQ or BEDQ. Using the standard conservative approach, compared with intraoperative diagnosis, sensitivity and specificity of the UGI series were 35.3% and 80.7%, respectively. Hiatal hernia was identified in an additional 34% (10 of 29) of patients randomized to posterior crural inspection.ConclusionHiatal hernias are highly prevalent in SG patients. However, GerdQ, BEDQ, and a UGI series unreliably identify hiatal hernia in the preoperative setting and should not influence intraoperative evaluation of the hiatus during SG.     

Sliding hiatal hernia in patients with gastroesophageal reflux: physiopathology and surgical treatment

BACKGROUND: The aims of the study were to evaluate how the sliding hiatal hernia, in patients with gastroesophageal reflux disease (GERD), acts on the lower esophageal sphincter (LES) and esophageal clearance, and how surgical therapy corrects the physiopathological parameters. METHODS: Records of 25 patients with only GERD and of 15 with GERD associated to hiatal hernia (> 3.5 cm) were reviewed. Ten subjects without symptoms and/or endoscopic and functional signs of GERD were considered as control group. The selection of the patients was done by reviewing radiographic examination, endoscopy and functional tests (esophageal manometry, pH-monitoring). RESULTS: Manometry showed a greater LES incompetence (pressure and length) and a worse peristalsis (distal amplitude) in the group with reflux and hiatal hernia against patients with reflux only. Also, patients with hiatal hernia had more acid exposure (total time pH < 4 in the distal esophagus) and a longer time of esophageal clearance, at pH-monitoring. The functional tests in 8 patients, before and after laparoscopic Toupet fundoplication with posterior closing of the crura, showed a normalised LES, esophageal clearance and acid exposure. Esophageal peristalsis did not show any statistically significance. CONCLUSIONS: The presence of hiatal hernia, in patients with GERD, causes worse LES, peristalsis and clearance with a greater acid exposure of the esophagus. Fundoplication, by reconstructing the sphincter-diaphragm unit, normalises the preoperative physiopathology situation but without an effective peristalsis improvement.     

Barrett's esophagus: its prevalence and association with adenocarcinoma in patients with symptoms of gastroesophageal reflux

The pathologic reports of all 1,020 esophageal biopsy specimens obtained between 1975 and 1981 in patients with symptoms of gastroesophageal reflux were reviewed. Barrett's esophagus was identified in 84 patients (8 percent). The 362 patients seen between 1980 and 1981 were reviewed in detail. The symptoms in patients with Barrett's esophagus differed from those of the patients without Barrett's esophagus. Dysphagia was more often present in the former group (34 percent versus 16 percent, p less than 0.05) and epigastric distress was less frequent (11 percent versus 27 percent, p less than 0.05). Objective findings of hiatal hernia, esophageal stricture, and esophageal ulcers occurred more commonly in patients with Barrett's esophagus than in those without Barrett's esophagus (70 percent versus 48 percent, 31 percent versus 4 percent, and 14 percent versus 6 percent, respectively, p less than 0.05). Mid esophageal strictures were associated almost exclusively with Barrett's esophagus (five of six patients). At esophagoscopy, erythema was seen more commonly with Barrett's esophagus. The diagnosis was suspected by the endoscopist in only 34 percent of patients subsequently demonstrated histopathologically to have Barrett's esophagus. There was no significant difference in the prevalence of a positive Bernstein test result or gastroesophageal reflux on upper gastrointestinal series in patients with and without Barrett's esophagus. However, a hypotensive lower esophageal sphincter was found more commonly in patients with Barrett's esophagus (100 percent versus 53 percent, p less than 0.05). Thirteen of the 84 patients with Barrett's esophagus (15 percent) had a coexistent adenocarcinoma arising from Barrett's mucosa. These patients, when compared with the patients with Barrett's esophagus without carcinoma, were more often male (77 percent versus 51 percent, p = 0.1), more often had dysphagia (69 percent versus 34 percent, p less than 0.05), and more frequently had a comparatively short duration of symptoms (67 percent versus 36 percent, p less than 0.05). Our findings suggest that patients with Barrett's esophagus have a high risk of development of carcinoma. Because the entity is often not recognized at endoscopy, routine esophageal biopsy should be performed on all patients undergoing esophagoscopy for symptoms of gastroesophageal reflux. Patients with known Barrett's esophagus should be followed closely with repeated endoscopy and biopsy.     

Laparoscopic management of giant type III hiatal hernia and short esophagus: Objective follow-up at three years

We wished to evaluate the long-term effectiveness of the laparoscopic Hill repair in the treatment of type III hiatal hernia. Fifty-two patients underwent laparoscopic repair of a type III hiatal hernia. No esophageal lengthening procedures were performed. Short esophagus was determined from the operative record. Late symptomatic follow-up and a satisfaction questionnaire were completed in 71% (37/52) of patients at a mean of 39 months (range 6 to 84 months). Esophagrams were completed in 65% (34/52) of patients at a mean of 3 7 months (range to 84 months) after repair. Eighty-one percent were without any adverse symptoms, and 86% rated outcome as excellent or good at 39 months. Symptoms requiring treatment were present in 19% (7/37). Esophagrams revealed a recurrent hernia in 32% (11/34) of patients of whom 36% (4/11) were asymptomatic. Six patients with short esophagus underwent esophagram with one recurrence identified (17%). This was compared with 28 patients without short esophagus, of whom 10 had a recurrence (35%) (P = 0.70). The laparoscopic Hill repair provides long-term satisfaction and relief of symptoms. The incidence of anatomic recurrence on video esophagram is high and does not always correlate with symptoms. The presence of short esophagus does not play a role in recurrence when the Hill repair is used. Presented at the Forty-Second Annual Meeting of The Society for Surgery of the Alimentary Tract, Atlanta, Georgia, May 20–23, 2001 (oral presentation). Deceased.