The authors reply

Excerpt

We appreciate the interest shown in our paper by Carlson and Frantzides. We studied 166 patients with large paraesophageal hernias (PEH), defined as the radiographic presence of more than one-third of the stomach in the chest cavity [1]. Only four patients (2.4%) underwent reoperation for hiatal closure failure. Another six patients (3.6%) required reoperation for recurrent symptoms of gastroesophatgeal reflux disease (GERD) or dysphagia and were found to have an intact hiatal closure. Six patients (5%) had radiographic evidence of recurrence of a true PEH, and an additional 20 patients (24%) had radiographic evidence of small type I sliding hernias. Two of the six patients with recurrent PEH and two of the 24 patients with small type I sliding hernias required reoperation. We question the clinical importance of these small type I sliding hernias, because most patients remained asymptomatic and obtained improvement of their GERD symptoms. Therefore, we do not believe that is justified to routinely reinforce the crural repair with prosthetic material. …