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It has been observed that not all large hiatus hernia patients have heartburn in their symptom profile at the time of their presentation. Therefore, the necessity of an anti-reflux procedure concurrent with the repair of the large hiatus hernia is contentious.
A small prospective cohort (21) of consecutive patients diagnosed with giant hiatus hernia were evaluated for symptoms of heartburn and regurgitation at any stage during the history. A pulmonary reflux aspiration scan was additionally performed to detect reflux events objectively.
Heartburn or regurgitation was present in the symptomatic history of 75% (15) of patients. The pulmonary reflux aspiration scan confirmed the occurrence of reflux events in 86% (13) of patients.
These data support the case for routine fundoplication when repairing hiatus hernia, unless otherwise contraindicated. Probably due to the configuration of para-oesophageal hiatus hernias, there is a diminution of reflux symptoms as the hernia progresses. Despite this presentation there is a high level of reflux symptomology and a high level of regurgitation shown objectively by scintigraphy, often culminating in pulmonary aspiration.