Gastroesophageal reflux disease surgery

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Gastroesophageal reflux disease Microchapters


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Historical Perspective




Differentiating Gastroesophageal Reflux Disease from other Diseases

Epidemiology and Demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]


Surgery is not the first-line treatment option for patients with GERD. Surgery is usually reserved for patients with either chronic GERD, high volume of acid reflux, non-compliant medical therapy, the presence of large hiatal hernia, or with upper respiratory manifestations as hoarsness of voice and laryngitits. The nissen fundoplication is the operation of choice in patients with GERD.


  • Surgery is not the first line of treatment of GERD. However, it can be as effective as the medical treatment in some cases of GERD.
  • Surgery is very effective in cases presenting with typical symptoms of GERD which are heart burn and regurgitation and patients who have ambulatory pH studies with good symptom correlation.[1][2]
  • Surgery is recommended for treatment of GERD in the following cases:
    • Gastrointestinal indications:[3]
      • Chronic GERD cases
      • High volume of acid reflux
      • Patients who do not desire to continue the medical therapy
      • Non-compliant medical therapy
      • Side effects associated with the medical treatment
      • The presence of large hiatal hernia
      • Complications associated with GERD like esophagitis and barrett's esophagus
    • Non-gastrointestinal indications:[4]
      • Upper respiratory manifestations as the following:
        • Hoarsness of voice
        • Laryngitis
        • Cough and aspiration
  • Surgical options:
    • Nissen fundoplication:
      • Nissen fundoplication is recommended for the patients with normal esophageal motility and uncomplicated cases.[5]
      • It can be performed by two ways, either total fundoplication or anterior 180 degrees partial fundoplication and both have the same outcome.
      • It is believed also that the nissen fundoplication results in improvement of the esophageal motility. In a performed study, it has been shown that nissen fundoplication caused improvement on the LES contractions.[6]
    • Other operations (Nissen modifications):
      • Belsey Mark IV
      • Gastric bypass (in obese patients)
      • Hill gastropexy
      • Angelchik prosthesis
      • LINX prosthesis


  1. Oelschlager BK, Quiroga E, Parra JD, Cahill M, Polissar N, Pellegrini CA (2008). "Long-term outcomes after laparoscopic antireflux surgery". Am J Gastroenterol. 103 (2): 280–7, quiz 288. doi:10.1111/j.1572-0241.2007.01606.x. PMID 17970835.
  2. del Genio G, Tolone S, del Genio F, Aggarwal R, d'Alessandro A, Allaria A; et al. (2008). "Prospective assessment of patient selection for antireflux surgery by combined multichannel intraluminal impedance pH monitoring". J Gastrointest Surg. 12 (9): 1491–6. doi:10.1007/s11605-008-0583-y. PMID 18612705.
  3. Zaninotto G, Attwood SE (2010). "Surgical management of refractory gastro-oesophageal reflux". Br J Surg. 97 (2): 139–40. doi:10.1002/bjs.6863. PMID 20069606.
  4. Downing TE, Sporn TA, Bollinger RR, Davis RD, Parker W, Lin SS (2008). "Pulmonary histopathology in an experimental model of chronic aspiration is independent of acidity". Exp Biol Med (Maywood). 233 (10): 1202–12. doi:10.3181/0801-RM-17. PMID 18641054.
  5. Ludemann R, Watson DI, Jamieson GG, Game PA, Devitt PG (2005). "Five-year follow-up of a randomized clinical trial of laparoscopic total versus anterior 180 degrees fundoplication". Br J Surg. 92 (2): 240–3. doi:10.1002/bjs.4762. PMID 15609384.
  6. Stein HJ, Bremner RM, Jamieson J, DeMeester TR (1992). "Effect of Nissen fundoplication on esophageal motor function". Arch Surg. 127 (7): 788–91. PMID 1524478.

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