[Surgical treatment of gastroesophageal reflux. Which technique to chose?]

Several procedures can be performed for gastroesophageal reflux disease. The aim of this review is to answer two main questions what are the validated procedures? should the procedures be tailored to patient? Surgical treatment is now based on fundoplications. Several controlled trials compared different types of fundoplications, the analysis of their results shows that the total and posterior fundoplications were equally effective at short-term. Total fundoplications were however more effective at long-term but with a higher morbidity. Technical variants include the ligation of short gastric vessels, the crura repair, the extend of the oesophageal overlapping by the partial fundoplication (180 degrees, 270 degrees, or 300 degrees), and the dissection of the vagus nerves. The choice of a procedure should also take into account oesophageal manometry and possible associated diseases. Lower oesophageal sphincter pressure does not appear mandatory contrary to impaired oesophageal body motility which should contraindicate a total fundoplication. For oesophageal stricture, current agreement is to perform a total fundoplication together with an endoscopic dilatation when it is feasible.