Surgical treatment of reflux esophagitis and stricture.

Surgical intervention is usually indicated in reflux esophagitis when medical therapy fails to control symptoms. Since most patients with peptic esophagitis also have a sliding hiatal hernia, early procedures focused on hernia repair. Weakness of the lower esophageal sphincter is now known to be the pathogenetic mechanism, and Belsey, Nissen, and Hill have developed operations to restore sphincteric function. The Hill repair is used most often because of its low incidence of side effects, but the other procedures are recommended in specific situations. Stricture, the most common complication of reflux esophagitis, presents a special problem in treatment because interference with swallowing is added to the characteristic symptoms of reflux. Because of its high long-term success rate, the combined Thal-Nissen procedure is preferred to forceful dilation plus an antireflux operation.