Key Points

• The evaluation of a patient possibly requiring surgical treatment of hiatal hernia and gastroesophageal reflux begins with a careful history.
• Essential evaluations are barium esophagography, esophagogastroduodenoscopy with biopsy, esophageal manometry, and 24 hour pH monitoring.
• Principles of antireflux surgery are reduction of the hiatal hernia with restoration of the intra-abdominal esophagus, repair of the esophageal hiatal mechanism, and reinforcement of the lower esophageal sphincter.
• Choice of the operation and modification will be dictated by patient evaluation.