Early experience with laparoscopic nissen fundoplication

Studies of the natural history of gastroesophageal reflux disease (GERD) indicate that most patients have limited disease responsive to simple lifestyle, dietary and medical therapy and do not go on to develop complications. Thus the majority of patients manifest a relatively benign form of the disease and do not need antireflux surgery. Indeed, expanding the indications for surgery to include patients with lesser forms of the disease will only serve to lessen the overall rate of successful surgery. However, approximately 25% of the patients with GERD will develop recurrent or progressive disease. It is this population of patients that is best suited to surgical therapy. Although at present there is no reliable method to identify which patients will develop progressive disease, there are several factors that predispose patients to complications and failure of medical therapy. These factors should be identified early in the course of therapy and taken into account when considering therapeutic alternatives.