Five years ago we published our first paper on the "Balanced Procedure" for correction of hiatal hernia with its associated abnormalities and dysfunctions. Now we have performed the operation upon approximately 400 patients. Three hundred of these have been carefully followed from 1 to 14 years. To this large number must be added many more treated by others along similar lines. The results are uniformly excellent, as the growing acceptance of our thesis indicates. Still all too often sight is lost of certain fundamentals.
The purpose of this paper is to emphasize again what our concepts of the "fundamentals" are and to substantiate further the validity of an approach that rests upon this thesis: Hiatal hernia in itself is but an anatomical abnormality, rarely significant unless either monstrous in size or associatedwith physiological and other anatomical derangements.1,2,3,6 The associated derangements cannot be ignored as the hernia is but