Fundoplication, using an abdominal approach, is advocated to create an adequate substitute for the insufficient sphincter in gastroesophageal reflux associated with hiatus hernia. To achieve success, correct indications for surgical treatment are important. Based on experience with approximately 1,400 patients over the past 20 years, these include: (a) a retrosternal burning sensation (in 90% of our cases); (b) objective confirmation of reflux by means of x-ray and endoscopic examination, together with biopsy examination of the esophageal mucosa and gastric acid evaluation; and (c) evidence of organic complications such as endobrachyesophagus with ulcerostenotic changes at the junction between the esophageal and gastric mucosa. Long-term follow-up of 590 patients with simple reflux esophagitis who underwent fundoplication showed that 87.5% were symptom free. In 44 patients with complicated gastroesophageal reflux disease, fundoplication produced clinical healing in 84.1%.

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A historical survey based on the most important literature is presented as a starting point for further discussion on the significance of possible adverse reactions reported after prescription of cotrimoxazole. The often changing and contradictory assessments made of the situation in different countries and at different times are outlined, and the difficulty of making a balanced and just evaluation of long established drugs is shown, particularly if the available data are derived primarily from spontaneous reports which, besides being almost impossible to verify, are often incomplete.

For many of today's clean-contaminated surgical operations antibiotic prophylaxis is a generally accepted and proven procedure. On the basis of a literature survey the parameters to be considered are analyzed: bactericidal spectrum, pharmacokinetics (peak plasma and tissue concentrations, tissue penetration, persistence at high-risk sites and elimination), minimal toxicity, absence of (above all, serious) adverse drug reactions (coagulation disorders, etc.), avoidance of resistance, suitability for single-dose prophylaxis even when the operation is unforeseeably delayed after the administration of the antibiotic, or when the operation lasts a very long time. Finally, the antimicrobial chosen must be cost-effective. The decisive factor, however, remains the proven clinical efficacy for the procedure concerned. There should be no prejudging of any issue until the relevant data have been collected, especially in the case of facts suggesting that single-dose antimicrobial agents are effective even in colorectal surgery, and that cephalosporins of the third generation might offer advantages over those of the first.