[GERD: surgical therapy]

Proton pump inhibitors (PPIs) are generally accepted as gold standard for treatment of gastro-esophageal reflux disease (GERD). Nevertheless, there are clear indications for surgical anti-reflux therapy. Principally, laparoscopic anti-reflux therapy is an excellent therapeutic alternative in all patients, who have objective or subjective problems with long-term PPI therapy. Clear cut proof of the symptomatic gastro esophageal reflux (endoscopy, 24 h pH-testing) is an absolute prerequisite for surgery. Partial or total laparoscopic fundoplication has replaced completely open operative techniques. Treatment of the hiatal hernia and the hiatoplasty are integral parts of the operation. Perioperative complication rate is low. The long-term results are good. Proper patient selection and correct indication for operation are most important in this respect.