Balanced Operations for Esophagitis Associated with Hiatal Hernia en Masse

In a previous communication1we described balanced operations in the treatment of persistent esophagitis associated with esophageal hiatal hernia. We also referred to previous discussions2,3concerning the classification of associated lesions with hiatal hernia and to theories concerning its probable pathogenesis. We defined esophageal hiatus hernia of the so-called sliding or short esophageal type as a cephalad displacement of the cardia above the diaphragm and called attention to associated infradiaphragmatic lesions. Hiatal hernia en masse is also a malfunction of several of the derivatives of the foregut; the parts of the alimentary canal nourished mainly by blood from the celiac axis and concerned principally with digestion. Thus, in a significant number of patients with hiatal hernia en masse there is an associated esophagitis, duodenal or gastric ulcer, biliary tract disease, and pancreatitis. Paraesophageal, parahiatal, or rolling type of hernia is defined as a hernia through the diaphragm in