Thirty-three cases of hiatus hernia treated by operation in an 8-year period are reviewed. It is suggested that less delay in surgical intervention when a child is not responding to medical management might reduce the number of children who develop strictures as a result of gastro-oesophageal reflux and might improve the development of the child. Gastric fixation with gastrostomy not only improves the nutrition of a child before a major corrective procedure, but in a few cases may avoid more drastic operation. Though maximal acid secretion tests do not help to identify those cases likely to develop a stricture, it is, however, a useful procedure in indicating whether or not vagotomy should be added to fundal plication.
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