Rizwan Qureshi, Kieren McManus, Karen Clement, James McGuigan.
Surgical Management of Gastro-Esophageal Reflux and Hiatus Hernia in a Thoracic Surgery Unit.
J Coll Physicians Surg Pak Jan ;11(5):311-4.

Few data have been published that permit comparison of the various surgical procedures used today for hiatal hernia, gastro-esophageal reflux disease (GERD), or both. The present study was aimed to evaluate efficacy of different surgical procedures performed for elimination of hiatal hernia and relief of symptoms and complications of gastro-esophageal reflux. Between 1987 and 1996, 134 patients undergoing a primary surgery for hiatal hernia, GERD or both were evaluated. Appropriate procedure was selected on the basis of the anatomical and functional findings assessed by means of barium, endoscopy, manometry and prolonged pH monitoring. Nissen fundoplication (n=85), by abdominal approach was mainly reserved for sliding hiatus hernia associated with GERD with minimal or no mucosal inflammation and normal motility on esophageal manometry. Thoracic (n=29) approach was considered in patients with esophageal shortening. Belsey Mark-IV (n=20) was the preferred procedure in the presence of impaired motility and no evidence of severe esophageal inflammation or shortening. The symptoms at review were assessed and graded according to previously published criteria. Patients with recurrent symptoms were fully re-investigated. Mean follow-up was 4.95 years (range 0.5-16 years). Overall excellent or good results were achieved in 123(91.79%) patients, 93.90% in trans-abdominal Nissen, 89.65% in transthoracic Nissen and 88.23% in BM-IV group, p = 0.02. These data suggest that where the appropriate procedure is selected, surgery can achieve satisfactory success rate.

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