Accurate Method of Diagnosing Hiatal Hernia

INTEREST in esophageal hiatal hernia has increased considerably since the classic publication of Allison,¹ who demonstrated a simple and effective method of curing the affection. However, problems in diagnosis of small hernias continue to be appreciable. By routine palpation of the esophageal hiatus at the time of abdominal exploration, we have discovered many hiatal hernias, in which we could insert up to two fingers to the distal interphalangeal joint, which we could not demonstrate subsequently by conventional radiological techniques.

To perform an adequate radiological examination one must locate the position of both the hiatus and the esophagogastric junction. Several investigators^2-4 have demonstrated, by inserting metallic clips into the edge of the hiatus at the time of surgery, that ordinary roentgenological techniques are comparatively inaccurate in localizing the region even when bony structures are used for reference. It has been demonstrated⁴ that the hiatus can be located accurately