Laparoscopic gastro-oesophageal antireflux surgery

Recent improvement in the understanding of gastro-oesophageal antireflux mechanisms and the pathophysiology of the gastro-oesophageal reflux disease (GERD) has warranted the concept that antireflux surgery provides a valid, and sometimes superior, alternative to medical therapy in selected patients. The main indications for surgical treatment of symptomatic GERD are: failure of medical therapy to heal ulcerative oesophagitis or to prevent recurrence of stricture or other complications, and the development of aspiration pneumonia or other airway complications. The Belsey and Nissen fundoplication and the Hill posterior gastropexy are the three most widely used surgical procedures to control reflux. The success rate of these operations, performed openly, in relieving symptoms and healing the lesions is 80-90%. The laparoscopic approach provides an interesting alternative in antireflux surgery. It affords a potential to reduce some inherent complications of conventional surgery, provided the operator is technically experienced and well aware of the pathophysiological principles of this disease. It is also superbly convenient to the patient. The currently published short-term results of laparoscopic antireflux surgery are comparable to those of open surgery, but the technique is still young, and its final evaluation is not possible until long-term results are available.