We would like to thank you for the opportunity to maintain this interesting discussion about hiatal hernias and when they should be treated surgically.
It is rather discouraging for surgeons to receive very elderly patients with severe respiratory complications secondary to recurring episodes of pneumonia or bronchitis due to the permanent aspiration of esophageal and gastric content reflux because of a hiatal hernia. And then there are those with complications from the hernia itself, such as severe anemia, active gastric ulcer, or volvulus. It is even worse when these patients were diagnosed with hiatal hernia several years earlier and were not recommended for surgery at that time. It is frustrating for surgeons because, by the time these patients are referred to us, the associated cardiorespiratory disease or the age of the patient do not make surgery recommendable, and the optimal time for surgical treatment has come and gone.
We have experienced this situation on numerous occasions throughout our careers as surgeons, so we felt it was necessary to alert surgeons when dealing with this condition.
Indeed, the article by Stylopoulos was reviewed and is mentioned in the References section. We do not agree with this article because, in addition to the methodological biases, there is a notable percentage of preventable complications derived from the patients’ baseline diseases, and it does not take into account the excellent results that laparoscopic surgery currently offers these patients.
We therefore remain convinced of our point of view, and we thank you for your comments that support the concept that we have proposed.
Please cite this article as: Braghetto I. Réplica a Carta al Director. Cir Esp. 2015;93:58.
