Sliding hiatal hernia per-se rarely causes symptoms directly, and most of the symptoms associated with it are actually caused by the accompanying gastroesophageal reflux. There has been an increased interest in the pathophysiology of gastroesophageal reflux disease and its rational surgical management. Recognition of the high failure rates after an anatomical repair of hiatal hernia led to the development of procedures designed to reestablish the competency of the cardia and improve its function.
The most popular of these antireflux procedures are: the trans-abdominal total fundoplication designed by Nissen in 1956, and the trans-thoracic partial fundoplication described by Belsey in 1966.
Nissen fundoplication is an effective and durable antireflux procedure and can abolish the symptoms and complications associated with gastroesophageal reflux disease.
The side-effects of the operation can be minimized by proper patient selection and attention to the technical details in constructing the fundoplication.
Transthoracic Belsey Mark IV repair has achieved results comparable to those of Nissen’s. It also has some specific indications, and as a partial wrap it avoids most of the obstructive side effects of Nissen procedure.
Recently laparoscepic fundoplication has proven to be safe and effective procedure, at least at short - term follow up. Major complications seem to be no more frequent with this approach than those described in open fundoplication.