Hiatal Hernia & Osteoporosis in Seniors: Treatment Options & Concerns

Question
Dear Doctor,
My mom is 81 & has severe osteoporosis with a large back hump that bends her forward over 20 degrees. She has had a hiatal hernia for years. Now that her organs are being compressed, the reflux is very bad. Many years ago she was told the hernia repair was one of the most complicated surgeries done, so she doesn't even want to discuss it with her own physical. Have techniques improved enough to make a repair in the elderly a reasonable option? Also, she is very diligent in her oral care but has horrible bad breath all the time. Could this be a side symptom from the constant reflux?
Thank you for your time.
Sincerely,
Trudy Finney

Answer
it is a hard call to make, but I would maximize her medical therapy including acid supressors like Nexium (PPI) along with Zantac (H2 Block) and then possibly Reglan or Amitiza along with it to help the food move thru the gut faster.... even tho the surg is easier, you don't want to put someone that age thru a major surgery unless you are forced to.  She should also eat small frequent meals instead of big ones.