[Technical and tactical development in antireflux surgery. What is left for the surgeon?]

Clinical research, increasingly objective diagnoses, tactical and technical progress have eventually led to the modification and improvement of antireflux surgery, although this evolution has not been without errors due to misinterpretation, faulty indications and methods. Conservative management has changed to include a whole gamut of pharmacological treatments, which have consistently tended to reduce indications for surgery--often rightly so, but doggedly at times. The present paper presents a review of our methods since the first fundoplication was performed, in 1955. Further achievements and adaptation of our methods to the different types of functional and organic reflux are discussed. The efficacy of surgery with predictable risk, good results and few side effects, even in the long run, permit us to make a case for this indication in a series of situations, where surgery is the sole logical solution for a less distressing life, as well as for avoiding dangers linked with irreversible organic complications. Methods and casuistics (over 2,000 personal cases) are illustrated in the course of this presentation.