To the Editor.—"Paraesophageal Hiatus Hernia," presented by Ellis et al1 in the Archives, described a series of 51 patients. The authors advised the addition to resection of the sac and anterior crural repair, a Stamm gastrostomy. Anterior gastropexy was not successful in preventing recurrence.
Nissen2 performed a transverse gastropexy for a paraesophageal hiatal hernia. This accomplished the same effect as a Stamm gastrostomy, which would fix the fundus of the stomach to the anterior abdominal wall without the need to enter the stomach. Closure of the hiatal orifice was not necessary, and he did not remove the sac. Symptomatic and roentgenologic cure resulted in 19 (90%) of 21 cases.
The cranial portion of the transverse gastropexy probably exerts traction on the muscle bundle of Willis to take care of any sliding element of the esophagogastric junction and prevents hypotension of the distal esophageal pressure zone, diminishing reflux