Before the 1990s, hiatus hernia repair and surgery for gastro-oesophageal reflux were undertaken sparingly via open surgical approaches, which were associated with significant morbidity. Subsequent laparoscopic approaches reduced morbidity, and shortened hospital stay and recovery time, and many patients then perceived surgery to be a much better option. This drove a rapid increase in fundoplication across the 1990s, and concurrently surgery concentrated towards subspecialist upper-gastrointestinal surgeons who found themselves managing much larger caseloads. Initially this increase was for gastro-oesophageal reflux, but subsequently surgery for very large hiatus hernias also increased significantly in many Western countries. Whilst some might consider this increase in surgery for hiatus hernia to indicate loosening of indications, indications for repair have not changed. Repair is largely undertaken for patients with mechanical symptoms, uncontrolled reflux, or, occasionally, chronic blood loss. Only a small subset of asymptomatic younger patients are recommended for repair, to prevent future issues, such as gastric volvulus. The debate for the asymptomatic group is around where the age cut-off threshold sits across the 60 to 70 years decade.
- Upper Gastrointestinal Surgery