[Evolution of views on surgical treatment of gastroesophageal reflux disease and hiatal hernia].
This year it has been 90 years since the first hiatal hernia repair was performed (Soresi, 1919). Nowadays surgeons' approach to operational treatment has changed as a result of development of more precise imaging techniques, better understanding of physiology and pathology of gastroesophageal reflux disease (GERD), invention of effective medicines and alternative endoscopic procedures. Complications and discomfort in patients during a follow-up resulted in evolution of surgical methods. Close co-operation between surgeons and gastroenterologists and interchange of experiences among surgeons have allowed establishing general algorithm for therapeutic and preoperational management. It seems crucial for further defining of surgical management of hiatal hernia and reflux disease to have at least basic knowledge on previous medical views on GERD. Another reason for taking the subject is epidemiology, oncological prophylaxis and quality of life improvement in patients with reflux disease. It has been proven that the most effective way of operational treatment of GERD is creating with the liberated gastric fundus a full "floppy" wrap around the lower esophagus. The procedure is completed with narrowing of esophageal hiatus. In cases of impaired esophageal motor activity the partial (180 degrees) posterior fundoplication is widely used. In hiatal hernias, particularly of type II or paraesophageal hernias, the diaphragmatic defect can be repaired with surrounding tissues or, when large, with a synthetic mesh.
Koziarski
Tomasz
T
Military Institute of Health Services in Warsaw, Department of General, Oncologic and Thoracic Surgery, Central Clinical Hospital of the Ministry of National Defense.
Paśnik
Krzysztof
K
Stanowski
Edward
E
Furga
Piotr
P
Trojanowski
Piotr
P
D000465:Algorithms; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D006551:Hernia, Hiatal / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D011300:Preoperative Care; D011788:Quality of Life; D013526:Surgical Mesh