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The changing face of treatment for hiatus hernia and gastro-oesophageal reflux
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It is paradoxical that recently the number of operations for gastro-oesophageal reflux and hiatus hernia has increased dramatically even though extremely effective medication for these conditions is now available in many, if not all, Western countries.1a The traditional indications for antireflux surgery still exist but they have been impacted upon by cultural factors, cost, and associated serious disease; so why do more people require surgery?
The most common indication for surgery used to be the failure of
medical treatment in severely symptomatic disease; however, so
effective are proton pump inhibitors (PPIs) at controlling the major
symptom of reflux
namely, heartburn, that this is a less common reason
for performing surgery today. Indeed, the failure of a patient to get
some degree of symptomatic relief from an adequate dosage of PPIs
should alert the surgeon to other problemsfor example, bile reflux,
irritable colon, functional dyspepsia, or gallstones. Yet, successful
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Oesophageal cancer
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Stomach and duodenum
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