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Related Concept Videos

Gastroesophageal Reflux Disease II: Clinical Features and Management01:29

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Gastroesophageal reflux disease, or GERD, is a persistent medical condition that affects many individuals worldwide. Its clinical manifestations can vary greatly, making diagnosis and management challenging for healthcare professionals. The following is a comprehensive overview of the clinical manifestations, assessment, and management strategies for GERD.
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An Esophagogastroduodenoscopy (EGD) is a diagnostic procedure in which an endoscopist uses a flexible, lighted endoscope to visualize the upper gastrointestinal (GI) tract. The procedure includes visualizing the oropharynx, esophagus, stomach, and the first part of the small intestine, the duodenum.
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Related Experiment Video

Updated: Dec 29, 2025

Author Spotlight: Recent Advancements in Reoperative Foregut Surgery
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Laparoscopic fundoplication for refractory GERD: a procedure worth repeating if needed.

Zia Kanani1, Jon C Gould2

  • 1Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.

Surgical Endoscopy
|February 5, 2020
PubMed
Summary

Reoperative fundoplication improves GERD symptoms, though less than primary surgery. Experienced surgeons can achieve similar complication rates for both primary and reoperative anti-reflux procedures.

Keywords:
FundoplicationGERD-HRQLGastroesophageal reflux diseaseNissenReoperative fundoplicationToupet

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Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Patient Outcomes

Background:

  • Laparoscopic fundoplication is the standard surgical treatment for refractory gastroesophageal reflux disease (GERD).
  • A significant percentage of patients (5-10%) require reoperation within 10 years of their initial laparoscopic fundoplication.
  • Comparing outcomes of primary versus reoperative procedures is crucial for patient management.

Purpose of the Study:

  • To compare symptomatic outcomes and morbidity between primary and reoperative laparoscopic fundoplication.
  • To evaluate the effectiveness of reoperative anti-reflux surgery in patients with persistent GERD symptoms.
  • To assess the safety profile of reoperative fundoplication performed by an experienced surgeon.

Main Methods:

  • Retrospective review of patients undergoing laparoscopic fundoplication between 2011 and 2017.
  • All procedures performed by a single, experienced foregut surgeon specializing in reoperative surgery.
  • GERD Health-Related Quality of Life (GERD-HRQL) scores used to assess symptomatic improvement pre- and post-operatively.

Main Results:

  • 136 primary and 82 reoperative fundoplications were analyzed.
  • Both groups showed significant GERD-HRQL score improvement at 2 years, with greater improvement in primary patients (p=0.02).
  • Reoperative procedures had longer operative times and hospital stays, but similar rates of moderate to severe 30-day complications (2.9% primary vs. 1.2% reoperative).

Conclusions:

  • Reoperative fundoplication offers significant symptom relief for GERD patients, though the degree of improvement is less than with primary surgery.
  • Experienced surgeons can achieve comparable perioperative morbidity rates for both primary and reoperative fundoplication.
  • Reoperative anti-reflux surgery is a viable option for patients with persistent GERD after initial surgery.