Laparoscopic surgery for hiatal hernia and peptic ulceration.

Antireflux and peptic ulcer surgery are ideally suited for the minimal access approach. There is no need for tissue retrieval, nor any compromise of surgical principles. Over the last five years there has been a tremendous expansion in both the number and types of these laparoscopic procedures and there is little doubt that minimal access antireflux surgery is here to stay. Medical therapy is expensive and laparoscopic surgery, with a reduction in pain, hospital stay and rehabilitation, has become an economic alternative, with the most commonly performed procedure being the Nissen fundoplication. Peptic ulcer surgery has been slower to develop. The economic argument is not as powerful and it is unlikely that we will see much increase in laparoscopic surgical treatment except for complications such as perforation, stenosis and bleeding. As yet, series are relatively small with early results and we await with interest the long-term results.