[Laparoscopic fundoplication--prevention of complications]

False indications, inadequate procedures and incorrect technique cause complications after laparoscopic antireflux procedures. Indication for operative treatment are esophagitis grade III and IV. Requirement of life-long treatment as well as persisting esophagitis after conservative treatment are indications in patients with esophagitis grade I and II. Preoperative evaluation includes endoscopy with biopsy, 24-h pH measurement and manometry. Therapy of choice is 360 degrees Nissen fundoplication analogue to the open procedure. In case of impaired esophageal contractility, a Toupet fundoplication is performed. Essential steps of the operative technique are prescribed with respect to potential peri- and postoperative complications. With crucial indication, careful preoperative evaluation and subtle technique, a fundoplication performed by an laparoscopic experienced surgeon is safe and efficient.