John C. Lipham1, Jin Ye Yeo2
1Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA; 2ALES Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. ALES Editorial Office, AME Publishing Company. Email: ales@amegroups.com
This interview can be cited as: Lipham JC, Yeo JY. Readers’ Choice: Author Interview with Dr. John C. Lipham. Ann Laparosc Endosc Surg. 2025. Available from: https://ales.amegroups.org/post/view/readers-rsquo-choice-author-interview-with-dr-john-c-lipham.
Expert introduction
Dr. John C. Lipham (Figure 1) earned his medical degree from the Medical College of Wisconsin, where he was elected to membership in the Alpha Omega Alpha Medical Honor Society. He subsequently completed his internship and residency training in general surgery at USC. During his training at USC, Dr. Lipham had the opportunity to gain further experience in general and foregut surgery by accepting a six-month position as a Senior Surgical Registrar in England. He then went on to complete a Thoracic & Esophageal surgery fellowship at USC under the direction of Dr. Tom DeMeester. He joined the faculty of USC in 2001.
Currently, Dr. Lipham is a professor of surgery with a focus on benign and malignant diseases of the foregut. His clinical interests include the diagnosis and treatment of GERD, esophageal motility disorders, malignant diseases of the esophagus and stomach as well as complex general surgery issues. His current research interests include developing less invasive methods of diagnosing and treating gastroesophageal reflux disease. He was instrumental in establishing the USC Digestive Health Institute.
Dr. Lipham’s article, “Which hiatal hernia’s need to be fixed? Large, small or none?”, published in our journal, has received an outstanding readership and entered the journal’s Most Read Article List.
Figure 1 Dr. John C. Lipham
Interview
ALES: What inspired you to pursue a career in foregut surgery, and what drew you to focus your research and clinical practice on gastroesophageal reflux disease (GERD) and esophageal disorders?
Dr. Lipham: The career was sort of chosen for me. My mentor during residency was Tom Demeester. He was considered the grandfather of anything related to the foregut and esophageal disorders. Early on in my residency, he took me under his wing and told me I should be a foregut surgeon. I said no, as I wanted to be a trauma surgeon, but he was very persistent. After a few years, he convinced me to do foregut surgery, and the next thing I knew, I was his thoracic and esophageal fellow and realized the passion and difference that I could make in the patients’ lives, and the rest was history. I have enjoyed my entire career trying to make a difference through these patients.
ALES: How has the field of foregut surgery evolved since you began your career, and what do you see as the biggest advancements?
Dr. Lipham: The biggest advancement is recognizing that foregut disease, whether it is surgery or gastroenterology, is its own specialty. During my training, foregut did not have a home. It was part of general surgery, gastroenterology, thoracic, and surgical oncology. It did not have its own home, nor was it recognized as a specialty. About 5-6 years ago, a group of us, surgeons and gastroenterologists, got together and realized that we needed to do something to make foregut its own specialty and give it a home. We started up the American Foregut Society, which I think is the most impactful change in foregut in the way we see foregut. Instead of being thought of as a little bit of every specialty, it is now recognized as its own specialty. Recently, in the last 2-3 years, the fellowship council has even developed, with the help of the American Foregut Society, fellowships for people interested in going into foregut.
ALES: You were instrumental in establishing the USC Digestive Health Institute. What was your vision when establishing the Institute, and how has it impacted patient care?
Dr. Lipham: The idea behind the institute was that patients want to be treated by specialists, and they want an area or place they can go for one-stop shopping. Within the institute model, take the foregut for example, foregut surgeons can work side-by-side with gastroenterologists specialized in the foregut, as well as oncologists, pathologists, and radiologists, all with interest in the foregut, trying to determine what is the best care for the patient. Within digestive disease, patients can get that multidisciplinary approach, which allows for personalized care.
ALES: Minimally invasive procedures are increasingly popular. Where do you see the future of endoscopic and robotic-assisted interventions in treating foregut diseases?
Dr. Lipham: We have come a long way in our treatment of foregut disease. When I was training, everything was done through big incisions in the chest and belly. Fast forward to where we are today, everything that we do is now being done either robotically or laparoscopically, through very small incisions that are less than an inch. The future, which is not too far off, is how many of these procedures are being done endoscopically. There is a convergence of gastroenterology and surgery in the endoscopic space. Now bring in robotic technology, this makes all these possible. Within the next few years, what we will see will be the merger of robotics and endoscopic gastroenterology and surgery. We will see endoscopic robotic platforms that will allow us to do a lot more procedures in the foregut than we could do with a regular endoscope. Such things as Peroral Endoscopic Myotomy (POEM), and endoscopic resections of early tumors will become easier and may even bring back the idea of natural orifice surgery or the third space endoscopy, where we can go outside the gastrointestinal tract and do interventions, such as hiatal hernia repair and other types of fundoplication. I see the field continuing to advance towards a less invasive approach to treating many of these diseases that we still treat surgically.
ALES: Your article, "Which hiatal hernia’s need to be fixed? Large, small or none?," has received widespread attention and recognition. What do you think it is about your perspective that resonates most with the surgical community?
Dr. Lipham: For a long time, there has been a heated debate about what constitutes the barrier to reflux. The majority of people, for the last 50 years, if they were asked that question, would say what prevents reflux is the lower esophageal sphincter. Not many people will mention the importance of the hiatal hernia or the integrity of the crural of the diaphragm. Because of that, our focus for the last 50 years has been trying to develop better techniques to treat the lower esophageal sphincter. Fast forward to today, what we have found in this article partly illustrates that the crural of the diaphragm, meaning not having a hiatal hernia, is at least 70% of the disease. This means that the crural of the diaphragm makes up at least 70% of the barrier. The lower esophageal sphincter only accounts for about 30% of the disease. What this illustrates is that we need to focus our research and industry support to come up with better ways to fix the hiatal hernia. The Achilles heel of any reflux procedure is the recurrence of the hiatal hernia. Our LES repairs do not tend to fail very often, but what fails is our crural repair, and the hiatal hernias come back. When it does, because it forms a large percentage of the barrier, the reflux comes back.
ALES: How do you see artificial intelligence (AI) and machine learning influencing diagnosis and treatment strategies in foregut surgery?
Dr. Lipham: They will have a major impact on the diagnosis and treatment strategies in foregut surgery. Current studies show that we are missing somewhere between 15-20% of patients with early esophageal cancer, which is usually not found for another year until it starts to present symptoms. AI will hopefully decrease the incidence of missed cancers by looking at an area, even if we cannot see it with our naked eyes, AI may be able to detect an abnormality which will lead us to a biopsy and hopefully decrease the missed cancer rate.
ALES: What advice would you give to young surgeons and researchers looking to specialize in foregut surgery?
Dr. Lipham: Get involved early on with the American Foregut Society. It is a multidisciplinary society between gastroenterologists and surgeons who are interested and focused on the foregut. The field of foregut is definitely merging between surgery, gastroenterology, endoscopic, and robotic, and the only society that can get them a taste of the aforementioned is the American Foregut Society.
Another piece of advice would be to always question dogma, whether they have an interest in the foregut or something else. What I have learned over my 3 decades of career is that there is a lot of dogma within surgery. What I mean by dogma is what our elders have told us is the best way to do things, but there is not a lot of data behind it. If there is no data to support why you are doing it a certain way, question that, and that may lead to very interesting changes in practice patterns. I think the importance of the hiatal hernias and the integrity of the crura is an example of what we learn when we question dogma.