Bilious vomiting after gastric surgery: A symptom of sliding esophageal hiatus hernia

Nine patients with bilious vomiting following gastric surgery for peptic ulcer were found to have sliding esophageal hiatus hernias; surgical repair of the hernia in each patient resulted in immediate relief of symptoms. Significant gastroesophageal reflux had been demonstrated in each of the 5 patients in whom preoperative cinefluorography had been performed. As a result of this retrospective analysis, it has been concluded that undiscovered sliding esophageal hiatus hernia is the cause of bilious vomiting in some of the patients heretofore thought to have the afferent-loop syndrome. It is recommended therefore that hiatus hernia be sought, and repaired if feasible, in all patients who are undergoing gastric surgery for peptic ulcer. As injury to the phrenoesophageal ligament at the time of abdominal vagotomy may lessen the competency of the lower esophageal sphincter and predispose to the development of an iatrogenic hiatus hernia, proper steps should be taken at the time of vagotomy to repair any significant operative defects. It is recommended further that cinefluorography be performed in all patients who return for follow-up examinations with symptoms characteristic of the afferent-loop syndrome.