[Which hiatal hernias require surgery?]

Several clinical situations may justify surgery for hiatal hernia. The approach varies depending on whether the problem is a mechanical complication or a gastro-oesophageal reflux responsible for oesophagitis, peptic stenosis, chest pain, respiratory disorders or Barrett's oesophagus. Recurrence of reflux after surgery raises even more complex problems. Evaluation by modern exploratory techniques helps in establishing precise indications for the operation which must, be reserved to selected cases.