[Surgical treatment of acid gastroesophageal reflux]

Recently, it has been demonstrated that the surgical treatment of gastro-esophageal reflux disease is superior to the medical treatment. Further, the surgical treatment gained new popularity because of the introduction and diffusion of laparoscopic techniques. A careful definition of gastro-esophageal reflux disease, based on the underlying pathophysiological abnormality (i.e.: an increased exposure of the distal esophagus to the refluxed acid juice), and a proper selection of patients candidate to surgery must however be maintained, together with a proper surgical technique, in order to achieve satisfactory results. In this paper, the authors outline in this paper the general principles of anti-reflux surgery and review the most recent results obtained with Nissen fundoplication as well as with other antireflux procedures. They describe in detail the surgical technique of the Nissen fundoplication ("Floppy" Nissen) by a laparoscopic approach. They review their experience in this with 15 operations performed since June 1992, and report the results of an Italian multicentric survey study on laparoscopic surgery for gastro-esophageal reflux disease. Recent series appeared in Literature are also reviewed. In conclusion, the authors underline the need for careful prospective studies and long-term clinical and functional follow-up of patients undergoing laparoscopic anti-reflux surgery before drawing definitive conclusions on its efficacy. However, early results seem to be really promising.